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SPEAKING ENGAGEMENT FORM

Please complete this form to request the Commissioner’s attendance at an event or meeting.  After we receive your request, we will contact you as quickly as possible about the Commissioner’s availability. 

Date:

Contact Information         

             


Phone

 

Do you employ a LOBBYIST? Yes NO

 


Type of Event:

 

Event Information:

 

Location of Event:

 

Directions:

 

Event Description ( Basic Nature and Purpose):


What would be the Commissioner’s participation (for example, welcome remarks, keynote address, participate in panel discussion, general discussion, etc.)


How many people do you expect to attend?


Start Time of Event: A.M. P.M. Time Zone:


End Time of Event: A.M. P.M. Time Zone:


What tme does the Commissioner need to arrive at event?
A.M. P.M. Time Zone:

 

Length of speech (estimate):


What would you like the Commissioner’s comments to address?


Attendees or other dignitaries that need to be recognized by Commissioner, if any:


Are there other speakers?


Is AGENDA available? Yes No

Please send AGENDA to: Sandy Troope (Sandy.troope@tn.gov ) or FAX 615-744-0078


Who will introduce Commissioner?


Do you need Commissioner’s BIO? Yes No

If BIO is needed, by what date?

Who should BIO be sent to? (include address)


Will you be sending a CONFIRMATION LETTER? Yes No

Can a GUEST accompany the Commissioner to this event? Yes No

Is A/V equipment available (for Powerpoint Presentation) if appropriate? Yes No

If the Commissioner is on a tight schedule, when can she step out (leave event)? Yes No

EXTRA ACTIVITIES – What might she be expected to do besides speak?


Will MEDIA be present? Yes No


OTHER INFORMATION