Commissioner Mike Strain DVM- Event Request Questionnaire
Event Name:
*
Host Organization:
Requested Role for Commissioner
Please Select
Keynote
Welcome
Brief Remarks
Drop By
Event Description:
What is the purpose of this event? Sponsors? Hosts? Agenda? (topic of discussion)
Topic of Commissioner remarks:
Number of Attendees:
Is there a Meet and Greet time?
Yes
No
Event Date
*
/
Month
/
Day
Year
Date Picker Icon
Event Occurance
Annually
Semi-Annually
Monthly
Weekly
One-time
Event Start Time
Hour Minutes
AM
PM
AM/PM Option
Event End Time
Hour Minutes
AM
PM
AM/PM Option
Event Location
*
Name of building or facility hosting the event
Room Name or Number
Location Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attire
Please Select
Formal (White Tie)
Formal (Black Tie)
Semi-Formal
Business (Coat and Tie)
Business Casual
Casual/ Sport
Unsure/ Don't Know
Event Contact Name
*
Phone Number
*
"Enter Numbers Only"
Format: (000) 000-0000.
Email Address:
example@example.com
What would you like the Commissioner to do at this event?
*
(EX: Speech, brief remarks, welcoming remarks, emcee, presentation of awards, etc.)
Approximate Time:
What is the anticipated time the Commissioner would actively participate at the event?
Background Info:
Will the Media be attending this event?
Yes
No
Invited
Please verify that you are human
*
Submit
Should be Empty: