City of Jacksonville

Event and Contact Information

Date of Event (with day of the week):*
Event Start Time:*
Event End Time:*
Mayor’s Participation Portion Start Time:*
Mayor’s Participation Portion End Time:*
Name of Event:*
Sponsoring Organization:*
Location of Event:*
Describe the space where the event will take place:*
Is the event space indoors or outdoors?:*	Indoors Outdoors Other
Street Address of Event (Include suite/room/floor number):*
City:*
State:*
Zip Code:*
Contact 1 Name and title:*
Contact 1 Cell Phone Number with Area Code:*
Contact 1 Alternate Phone Number with Area Code:*
Contact 1 Email Address:*
Contact 2 Name and title:*
Contact 2 Cell Phone Number with Area Code:*
Purpose of Event (Why are you asking the mayor to attend?):*
Name of Person who will meet the mayor at the door?:*
Cell Phone Number of Contact who will meet the mayor at the door:*

Organization Information

Organization’s Most Recent Accomplishment/Proudest Point:*
Other Background Information about your organization (website, mission statement, etc.):*

Event Set-Up

Where will the mayor's vehicle park?:*
Are you requesting the mayor to speak at this event?:*	YesNo
*Please indicate the type of remarks from the list below:*	Select Value Welcoming Remarks (2-3 minutes) Brief Remarks (3-5 minutes) Keynote Speaker (5-7 minutes) Closing Remarks (2-3 minutes) News/Press Conference (2-3 minutes) Other
*Question & Answer Session?:*	YesNo
*Who would you like to introduce the mayor?:*
*Title of Person who would like to introduce the mayor:*
*Approximate time during the program the mayor would speak:*
*Topics you would like the mayor to address in her remarks:*
*Recommended acknowledgments of organization leaders to include in the mayor's remarks:*
*Will there be a microphone set up?:*	YesNo
*Will there be a podium set up?:*	YesNo
Number of Attendees:*
Approximate number of attendees:*
Seating arrangements (Where will the mayor be seated and with whom?):*
Describe the theme and atmosphere of this event:*
Audience Composition (Organization Members, Students, National/Local Audience, etc.):*
Suggested Attire:*	Formal Business Business Casual Casual
Audience Attire:*	Formal Business Business Casual Casual
What other elected officials/business leaders/community leaders/faith-based leaders are confirmed to attend?:*
Is media invited to this event?:*	YesNo
Is filming video permitted at this event?:*	YesNo
Is photography permitted at this event?:*	YesNo
Describe the event agenda/program/run of show or attach a file below (minute by minute agenda required):*
Attachment 1:
Attachment 2:
Attachment 3:

Alternative Representative

If the mayor is unavailable, would you like an alternative representative from the mayor's office to attend:*

Yes No

 

Is correspondence (a letter or proclamation) from the Mayor needed for this event? If yes, please provide information for the correspondence here.