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OSC-0001 - Comptroller Event Request Form
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Requester Info
First Name
*
Last Name
*
Suffix
Value is not selected
-- Select one --
II
III
D.V.M.
D.D.S.
Esq.
Family
Jr.
L.L.D.
M.B.A.
M.D.
Ph.D.
R.N.
Sr.
Relationship/Title
Email
*
Email
form field Email
is not in correct form
Phone Number
*
Phone
form field Phone Number
must be in the format: (000) 000-0000
Cell Phone Number
Phone
form field Cell Phone Number
must be in the format: (000) 000-0000
Organization Info
Organization Name
Organization Website
Organization Social Media Links
Event Info
Event Name
*
Event Date/Start Time
*
Date
form field Event Date/Start Time
must be in the format: MM/dd/yyyy hh:mm tt
Event Date/End Time
*
Date
form field Event Date/End Time
must be in the format: MM/dd/yyyy hh:mm tt
Is the Event in-Person or Virtual?
*
In-Person
Virtual
Event Topic or Theme
*
Purpose of Invitation and Event
Is this event a fundraiser?
*
Yes
No
Who is the Audience?
Anticipated Audience Size
*
Form field Anticipated Audience Size has
Invalid numeric value.
Are other guests of honor invited?
Yes
No
Other Guests of Honor, if applicable
Event Sponsor(s) Other Than Requester (if applicable)
Is your event open to the media?
*
Yes
No
Will this event be recorded, live-broadcasted, or streamed?
*
Yes
No
Include any additional details about the event
*
Role of the Comptroller
Attendee
Presenter
Panelist
What topic(s) would you like the Comptroller to discuss?
Venue Name
*
Venue Address
*
Venue Address Cont. (optional)
Venue City
*
Venue State
*
Value is not selected
-- Select one --
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Venue Zip OR Zip+4
*
Date of Submission
*
Date
form field Date of Submission
must be in the format: MM/dd/yyyy
Email Address:
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