State of Alabama: Office of Governor Robert Bentley

Event Request

The following form should be filled out if you would like the Governor to speak at or attend an event.

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Event Name: (Required)
Event Date: (Required)	Event Time: (Required)
Physical Location of Event:
Location Name: (Required)
Address: (Required)
Event City: (Required)	Event State: (Required)
Event Zip: (Required)
Affiliated Organization(s): (Required)
Authorized Contact Information:
Your First Name: (Required)	Your Last Name: (Required)
Organization:	Position/Title:
Work Phone Number: ( ) - -	Cell Phone Number: ( ) - -
Home Phone Number: (Required) ( ) - -	Email Address: (Required)
Street Address:(Required)
City: (Required)	State: (Req)		Zip Code: (Req)
Would you like the Governor to: Attend Featured/Keynote Speaker Brief Remarks Recognized Guest Other Officials or special guests who are confirmed to attend: Description of Event/Event Details (Please be as specific as possible): (Required)
Number of Attendees?		Open to Public?
First Lady Invited?		Open to Media?

If the Governor is unable to attend, would you be open to someone else from the Governor's office attending? If yes, is there anyone specific that you would like to request?

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