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Mayor's Event Participation Form

2. SHARON WESTON BROOME
   Mayor-President of East Baton Rouge

5. 

8. Thank you for contacting the Office of the Mayor. Once we receive your invitation, we will contact you as quickly as possible with the Mayor’s availability. Please be advised, that the Mayor's availability cannot be confirmed before 2-3 weeks prior to the event. If the Mayor cannot attend the event, please advise whether a representative from Mayor's office would be acceptable.

10. 501c3 Organization*

    1. Yes
    2. No

11. Add your website address below

13.  Event Information

15. Event Start Date/Time*
    Event Start Date/Time

    Event Start Date/Time

16. Event End Date/Time
    Event End Date/Time

    Event End Date/Time

18. Name of Requested Event*

19. Sponsoring Organization

21. Name of hotel/building

22. Number of Attendees*

24. Street Name

26. City

27. State

28. Zip Code

30. Event Type*
    -- Select One --LuncheonDinnerReceptionGala/BallConferenceRibbon Cutting/Grand OpeningSpeaking EngagementSeminarFestival

31. Suggested Attire*
    -- Select One --Black Tie/FormalBusiness CasualCasualOther

32. Other Suggested Attire

33. Inside or Outside Event*
    -- Select One --IndoorOutdoorBoth

35. Other Attendees*
    -- Select One --Business LeadersCommunity LeadersElected OfficialsFaith-based LeadersVIP

36. Will Media be Invited?*
    -- Select One --YesNo

38.  Mayor's Participation Information

40. Mayor's Participation Portion Start Date/Time*
    Mayor's Participation Portion Start Date/Time

    Mayor's Participation Portion Start Date/Time

41. Mayor's Participation Portion End Date/Time
    Mayor's Participation Portion End Date/Time

    Mayor's Participation Portion End Date/Time

43. Mayor's Greeting Party*

    Name of person to meet the Mayor at the door.

44. Mayor's Greeting Party Cell Phone Number*

46. Parking*

    Where will the Mayor park?

48. Are you requesting the Mayor to speak at this event?*
    -- Select One --Brief RemarksClosing RemarksKeynote SpeakerNews/Press ConferenceWelcome RemarksNoOther Remarks(describe below)

49. Will there be Question and Answer Session?*
    -- Select One --YesNo

51. Other Type of Remark

53. Mayor's Arrival Time*
    Mayor's Arrival Time

54. Speech Slot Time*
    Speech Slot Time

55. Speaking Time

    For how many minutes would you like the mayor to speak?

57. Discussion Topics*

    Topics you would like the Mayor to address in her remarks.

59. Acknowledgments

    Recommended acknowledgments of organization leaders to include in the Mayor's remarks.

61. Will there be a microphone setup?
    -- Select One --YesNo

62. Will there be a podium setup?
    -- Select One --YesNo

64. Seating Arrangements*

    Where will the Mayor be seated and with who?

66.  Contact Information

68. Primary Contact Full Name & Title*

69. Organization *

71. Phone Number*

72. Contact Email*

74. Alternate Phone Number

75. Alternate Email Address

77. Alternate Contact Full Name & Title

78. Alternate Contact Phone Number

80. Relevant Background Information About Organization

82. Organization's Social Media

    Please list your organization's social media accounts.

84. Coordinating Organizations

    Please list the names of Coordinating Organizations for this Event.

86.  

    (Upload Documents/Pictures/Video) txt, pdf, doc, docx, gif, jpg, png, avi, mov, mp3, mp4, wav files only; 14 MB max

88. **Only use the official biography and or photo of Mayor President Sharon Weston Broome provided by office.**

    
    Please attach talking points, fact sheets and website for more information about your event organization, etc.
    
    Note: The Mayor is a pescatarian, consuming only fish, seafood, and vegetarian entree options.
    
    Mayor-President Sharon Weston Broome will not accept honorariums.
    
    In addition to the completed Mayor's Event Participation Form, please provide copies of promotional materials related to this event (photos, press releases, flyers, etc.)

90. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
91. Electronic Signature

Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit Submit and Print

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