DHS Secretary & Executive Leadership - Event Attendance/Speaker Request Form

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Please use this form to request the DHS Secretary or a member of the DHS Executive Leadership Team attend and/or speak at your upcoming event or meeting.

Please submit your request as far in advance as possible. We will respond within 48 hours. Due to competing scheduling priorities, it is unlikely we will be able to accommodate requests made within 2 weeks of an event.

What is the name(s) of the DHS Executive(s) you are requesting attend and/or speak at your event? *

Please indicate "Unknown" if you are not requesting a specific speaker.

What is the date of your event? *

YYYY

What time does your event start and end? *

Time

Where is your event being held? *

(include zip code)

What is the name of the primary point of contact for your event? *

What is the mobile phone number for the primary point of contact for your event? *

What is the email address for the primary point of contact for your event? *

Is DHS Leadership being asked to speak at the event? *

If Yes, please note DHS requires you share draft talking points with your assigned DHS contact no later than 10 days before the event.

Will press/media be at this event? *

Yes

Is the event being held in-person or virtually? *

Yes

Is the event location accessible to the public? *

Yes

N/A

Will you have a photographer taking photos or video? *

Yes

Not yet known

Is the event being videotaped or live streamed? *

Yes

Not yet known

Tell us about the event agenda/itinerary, including all confirmed or invited speakers. *

(specifically note what parts of the agenda require DHS Leadership’s participation)

List any other invited or confirmed VIPs or elected officials attending the event. *

(please include their name, title, agency/organization name, role)

Where will the DHS Executive be speaking? *

(list as many details as possible. Examples: on stage, at a podium, with a microphone, no microphone, etc)

Will the DHS Executive be required to present a PowerPoint or other presentation? *

If Yes, please note DHS requires you share draft PPT with your assigned DHS contact no later than 10 days before the event.

Who generally be attending this event? *

Describe the audience

How many people do you estimate will be in attendance? *

List any DHS staff who will also be in attendance *

(name, title, dept or local DSS office)

Is there any specific seating placement for the DHS Executive(s) and/or DHS staff in attendance? If so please provide details below. *

Will parking be provided? *

Yes

Location of parking being provided *

(if parking is not being provided, please provide exact location of where the DHS representative should park)

Event attire *

(professional, formal, casual, etc.)

Layout of venue and/or website of venue (if available). If you have this available as an attachment (diagram, etc.), please indicate below *

Any additional information you can provide to ensure DHS Leadership has everything they need to successfully represent DHS? *

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