2. Interested in having an Arapahoe County Commissioner speak at your event? Please use this form to request a Commissioner appearance. Please note that because of the large volume of requests and due to busy schedules, we cannot always guarantee that a Commissioner will be available. We will follow-up within three business days after receiving this form to discuss options.
4. First Name*
5. Last Name*
6. Prefix*

   1. Mr.
   2. Mrs.
   3. Ms.
8. Email:*
9. Confirm Email:*
11. Phone Number:*
    Please include dashes
13. Is the requester the main point of contact?*

    1. yes
    2. no
15. If answer above is no, please fill out below
17. Contact First Name:
18. Contact Last Name:
20. Contact Email:
21. Contact Phone Number:
23. Name of group/organization:*
25. Purpose of group/organization:*
27. Event Name:*
28. Event Date and Time*
    Event Date and Time Start Date

    Event Date and Time Start Time

    —

    Event Date and Time End Date

    Event Date and Time End Time
    Date of event MUST be at least one week in advance with the understanding all requests might not be accommodated
29. Is this date fixed or is it flexible?*

    1. fixed
    2. flexible
31. Event Location:*
33. Address1*
35. Address2
37. City*
38. State*
39. Zip*
41. Event Description and Purpose:*
43. Event Attire*

    1. Business
    2. Business Casual
    3. Black Tie
    4. Informal
    5. Other
44. If other, please describe
45. Estimated number of people in attendance:*
47. Who would you like to attend:*

    1. Carrie Warren-Gully, District 1
    2. Jessica Campbell-Swanson, District 2
    3. Jeff Baker, District 3
    4. Leslie Summey, District 4
    5. Bill L. Holen, District 5
48. Will they need to speak at this event?*

    1. Keynote
    2. Brief Remarks
    3. Opening Remarks
    4. Closing Remarks
    5. Attendance Only
    6. Other
49. If other, please describe:
51. Desired length of time to make remarks:*

    1. 5 min.
    2. 10 min.
    3. 15 min.
    4. 30 min.
    5. Other

    If more than one Commissioner is requested to attend and speak, please use the other box to describe time needed per Commissioner
52. If other, please list amount of time
53. Speaking points or addition information please attach
55. Please attach and agenda and/or provide names/topics of other speakers
56. Do you anticipate media attendance or coverage?

    1. yes
    2. no
58. Notes or special instructions
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field