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Secretary of State Weber’s Role at Event *

Is this a speaking request, invitation to attend an event, or a pre-recorded video request? *

Recorded Video Request

Length of video *

You have 50 words left.

Draft of script

Video format (cloud file, google link, mp4, etc)

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Please provide link or email address to receive video *

You have 100 words left.

Will video be shared privately or publicly? *

You have 100 words left.

If public, please provide link to website

Event Details

Name of Organization *

You have 25 words left.

Title of Event *

You have 25 words left.

Date of the Event *

Time of Event *

Where will the event be held?

You have 100 words left.

Is this event in person or virtual?

Is this event indoor or outdoor?

Location on the property (ballroom, conference room, etc.)

Please describe purpose of the event and provide any historical background. Include a weblink if available

You have 500 words left.

Is this event a fundraiser?

If a fundraiser, please indicate the price of the ticket

Describe the audience for this event (i.e.: general public, organization members)

You have 500 words left.

Estimated number of attendees

You have 200 characters left.

Please describe the format of the event? (Is this a panel, fireside chat, etc.)

You have 500 words left.

Please list any co-panelists and include short bio for the panelist(s) (i.e.: LinkedIn, webpage, CV)

You have 1000 words left.

In person: Please describe the COVID-19 protocols in place for this event

You have 1000 words left.

What other elected officials have been invited and/or will attend?

You have 1000 words left.

What is the suggested attire for the event?

You have 50 words left.

Please provide any additional information that may be helpful. (flier, event website etc.)

You have 1000 words left.

Video recipient *

You have 50 words left.

Please include event agenda or run-of-show (draft is acceptable)

You have 2000 words left.

Please note: videos can only be used for the purpose requested. Video cannot be used for political or commercial purposes.

Requestor Information

Requestor Name *

Requestor Email *

Requestor Phone Number *

Day of Event Contact Name if different from Requestor *

Day of event contact mobile number (area code + phone number) *

Please provide any additional information that may be helpful. (event website, etc.)

form-test-2-21-2023

Test Page Only - Not For Public Use

Recorded Video Request

Event Details

Requestor Information

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