Group or individual(s) making request:

Phone:

Office:

Mobile:

Email Address:

Date:Please enter date Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year

Time: a.m. p.m.

Location: (include address, building, room number, and entrance)

Length of speech:

Topic of speech:

Who will be in attendance? (include special guests):

How many attendees are expected:

Will there be a microphone? Yes No

Will there be a podium? Yes No

Will media or press be involved? Yes No

What is the dress?:

Please provide an agenda or schedule:

Comments:

Time

• Please keep in mind that Lieutenant Governor Bell's schedule may change at any time, based on current state needs and responsibilities at the time. If this occurs, we apologize for any inconvenience and appreciate your understanding.
• Any press releases, sound bytes, printed material, etc that use Lieutenant Governor Bell's name or quotes must be approved by the Office of the Lieutenant Governor before being distributed. If you are unwilling to do this, the Lieutenant Governor will be unable to participate in your event. Submission of this form indicates that you understand and accept these terms.
• If the Lieutenant Governor is available to attend your event, you will receive a request for talking points by email. Talking points must be returned to the Lieutenant Governor's office within five days.
• A brief biography of the Lieutenant Governor is available at: http://www.utah.gov/ltgovernor/about/index.html