Official Speaker Request

Mayor's Office
2777 East Point Street
East Point, Georgia 30344

Office: (404) 270-7091 | | Fax: (404) 765-1014
Email: Mayor@EastPointCity.org
Website: www.eastpointcity.org

Official Speaker Request
*Please return this form via email, fax or mail to: Mayor's Office (see above).

Event Name:*

Affiliated Organizations:

(if applicable)

Event Date:*

MonthDayYear

Event Time:*

:HourMinutesAM/PM Option

Event Location:*

Event Address:*

Event Telephone:*

Event Fax:*

City Council Ward:*

Requested Speaker:*

Role of the Speaker:*

City Official's Name:*

Alternate Speaker:*

(if requested speaker is unavailable)

Will Speaker be required to attend the entire event?*

YesNo

Will the event be indoors or outdoors?*

IndoorsOutdoors

Purpose of the Event:*

History of the Event:

(optional)

Event Contact Person:*

Event Contact's Position:*

Event Contact's Address:*

Event Contact's Telephone:*

Event Contact's E-mail:*

Local Media Invited:*

Other Event Contact:*

(in case of emergency)

Telephone:*

Type of Event:*

CivicPersonal MeetingSpecial EventOther

Attire:*

Black TieBusinessCasual

Please provide details about the group/audience that would be helpful to the City (i.e. background on the organization, organization web site, representatives of a specific region, audience's interests). Background information may also be attached separately or sent via email and/or fax.*

Please list the key issues of importance to the organization and/or specific issues that the group would like the City Official to address.*

Other officials or special guests to attend:*

Who will be seated with the Mayor/Manager/City Official?:*

Number of Attendees:*

Open to Public?*

Open to Media?*

Who else will be speaking?*

(Names and Titles)

Who will introduce the Speaker?*

(Name and Title)

Approximate Introduction Time?*

:HourMinutesAM/PM Option

What takes place immediately before?*

What takes place immediately after?*

Other Event Notes:

Please note that this form must be completed within 7 days of initial request and 14 days before actual scheduled event for processing and to ensure participation.

Signature:*

Mission Statement
To provide exceptional city services in the most professional, courteous and effective manner to enhance the quality of life in the City of East Point.