Supervisor Susan Ellenberg Meeting Appearance Request Form

Meeting Name

Meeting Date

Meeting Time (total)

Meeting Location & Address (Put "virtual" if an online event)

Role for Supervisor Ellenberg

Meeting Purpose/Intention

Meeting Audience Description

Estimated Number of Attendees

Approximate Length of remarks by Supervisor Ellenberg (in minutes, specify if time allotted includes Q&A)

Topic(s) or desired theme of Supervisor Ellenberg's remarks

Agenda/Run of show (Specify whether draft or final)

Parking Information (Put N/A if event is virtual)

Commendation or Certificate Requested?

Meeting Contact Person Name

Meeting Contact Person Phone

Meeting Contact Person Email

Meeting Url or Website

Additional details (format, run of show, other speakers, whether there is a cost for attendees, etc.)

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