Governor Jim Gibbons -- State of Nevada

Event Request Form

Please fill out the following information to invite the Governor to your event. Please note that due to the volume of requests the Governor receives not all requests will be granted. You will be contacted regarding your request in 1-2 weeks from the date your request was submitted. ONLY REQUESTS FOR EVENTS THAT ARE WITHIN 60 DAYS FROM TODAY WILL BE CONSIDERED
Event Title:

Name of Organization/Group:

Event Location:

Date of Event:

Time of Event:

Is this a request to have the Governor Speak at your event?		Yes No

Your Contact Information:
Name:
Phone #:
Email Address:

Organization/group background info:

Any other essential information pertaining to your request:

Key Attendees & Invitees: (list all)

NOTE: Due to the high volume of requests please be aware that the Governor is unable to accommodate every request.