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Survey/Form Review
Mayor Gray Schedule Request Form

Requester Contact Information

Name ( first and last )

Address: ( street, city, state, zip code )

Phone Number:

Email Address:

Event Information:

Name of Event:

Event Sponsor/Organization:

Event Date: (mm/dd/yyyy)

Event Run Time: ( ex. 5:30 pm - 7:30 pm)

Suggested Time Mayor Gray Should Arrive:

Event Location/Address: ( street, city, state, zip code) + ( on-site directions: floor, room, etc.)

Who will meet Mayor Gray upon his arrival?

Day of Event Contact:
Name:

Mobile Phone Number:


Estimated Event Attendance:

Other Invited Guests of Honor/VIPs:

Attire:
Speaking Engagement? *
Type and length of remarks:
If "other" please specify:

Who will introduce Mayor Gray?

Discussion Topics:

Event Format:
If "other" please specify:

Will members of the media be invited?
If "Yes" please specify:

Is this event open to the public?
Other background information on your event:


Will you accept a representative if Mayor Gray cannot attend?
Please email any additional event related flyers/agendas/documents to: maureenw@lexingtonky.gov

I would like to sign up for Mayor Jim Gray's newsletter!

Disclaimer: Before you submit this e-mail form, we would like to make you aware of LFUCG policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: 1) is subject to public disclosure under the Open Records Law, 2) is not private or confidential and 3) is retained for one month.