Webform to request the Commissioner to speak at a specific event. GENERAL INFORMATION Organization Name: Event Name: Event Street Address: Event Room Name/Room Number: Event City: Event State: Event Zip: Event Date: Event Time: POINT OF CONTACT Title: Name: Email: Cell Phone Number: DAY OF CONTACT Title: Name: Email: Cell Phone Number: EVENT INFORMATION Event Purpose: Event Start Time: Event End Time: Check in time for Speaker: Please describe the Commissioner's role at the event: Attire: Audience Size: Photo Ops: Podium Available?: Yes No Seated Panel: Yes No Please note setup for your speaking area: Riser Floor Level Stage Microphone Type: Fixed Microphone Lavalier Wireless Microphone (Preferred) No Microphone Topic of Requested Remarks: Length of Remarks (Minutes): Time for Q&A (Minutes): Media Event: Open Closed Venue Location: Indoor Outdoor ADDITIONAL INFORMATION Please list other invited elected officials or VIPs: Who will introduce Commissioner Buckingham prior to her remarks?: List Event Sponsors: Dias/Head Table Guests: AV Equipment Available? Yes No Additional Details: With few exceptions, an individual is entitled on request to be informed about the information that the state governmental body collects about the individual. Under Sections 552.021 and 552.023 of the Texas Government Code, the individual is entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, the individual is entitled to have the state governmental body correct information about the individual that is incorrect.