Invite Commissioner Mike Kreidler to an event

*Organization name

*Your name and title

*Daytime phone

(xxx-xxx-xxxx)

*Contact e-mail

(A copy of this request will be sent to this e-mail address.)

Organization address

Organization website

We invite Commissioner Kreidler to be our:

*Commissioner's Role

*Would your organization consider an alternate speaker from our office, if the Commissioner was unable to attend? Yes No

On the following date and time:

*Date of event

(mm/dd/yyyy)

*Time of event

(hh:mm am/pm)

Any alternative event dates you would like us to consider? (Please explain.)

Step 3. Event details

*Event title/name

Subject/theme of event

*Estimated attendance

Will the media be invited?

Yes No

*Location of event (include address and room name):

Describe audience members (ex: business leaders, insurance agents, senior citizens. Any VIPs?):

Has the Commissioner spoken to your group before? Yes No

If Yes, approximately when.

*Speech topic

Start time of speech

(hh:mm am/pm)

*Time allotted for speech

Time for audience Q&A

Will there be a microphone? Yes No If yes, please specify type

Who else is speaking?

(name and title)

*Please provide specific details of the requested topic so that we may expedite your request:

How is the room set up (podium, tables, theatre-style seating, etc.)?

Who will introduce the Commissioner?

(name and title)

Will a meal be served?

Yes No

Do you need a bio/photo?

Yes No

Any additional information you'd like to share?

Invite Commissioner Mike Kreidler to speak at your event

Step 1. Your contact information
*Organization name
*Your name and title
*Daytime phone	(xxx-xxx-xxxx)
*Contact e-mail	(A copy of this request will be sent to this e-mail address.)
Organization address
Organization website
Step 2. Type of request
We invite Commissioner Kreidler to be our:
*Commissioner's Role
*Would your organization consider an alternate speaker from our office, if the Commissioner was unable to attend? Yes No
On the following date and time:
*Date of event	(mm/dd/yyyy)
*Time of event	(hh:mm am/pm)
Any alternative event dates you would like us to consider? (Please explain.)
Step 3. Event details
*Event title/name
Subject/theme of event
*Estimated attendance
Will the media be invited?	Yes No
*Location of event (include address and room name):
Describe audience members (ex: business leaders, insurance agents, senior citizens. Any VIPs?):
Has the Commissioner spoken to your group before? Yes No If Yes, approximately when.
Step 4. Speech details
*Speech topic
Start time of speech	(hh:mm am/pm)
*Time allotted for speech
Time for audience Q&A
Will there be a microphone? Yes No If yes, please specify type
Who else is speaking?	(name and title)
*Please provide specific details of the requested topic so that we may expedite your request:
How is the room set up (podium, tables, theatre-style seating, etc.)?
Step 5. Logistics
Who will introduce the Commissioner?	(name and title)
Will a meal be served?	Yes No
Do you need a bio/photo?	Yes No
Any additional information you'd like to share?