Speaking Request/Event Invitation

Please complete this if you would like Supervisor Sarmiento to speak to your organization/group or attend your event.

Please note: Due to the high volume of requests, if the Supervisor is unable speak to your group or attend your event, an appropriate staff member may be assigned to represent the Supervisor. We will try our very best to fulfill most requests, but please be aware that submitted requests are not guaranteed for fulfillment.

Full Name

First

Last

Title/Affiliation/Role with the Organization

Your Phone Number (best number to reach you)

Date and Time of Event

What type of event is this?

Banquet/Award

Community Event/Festival/Concert

Ribbon Cutting/Grand Opening

Membership Organization Function (Chamber of Commerce, Neighborhood Association, etc.)

Other - Please elaborate:

Event Flyer

Please upload any attachments like a flyer or anything for more information about the event

Upload requirements

Requested Role

Remarks/Speech

Panel

Q&A/Interview Format

Guest (No Speaking Role)

Other – please elaborate

Please Provide a Description of the Event, Including Estimated Amount of Attendees

Please Describe Supervisor Sarmiento’s Role. If speaking, please elaborate on topic and expectations

Are Other Elected Officials/Dignitaries Invited or Expected to Attend? If so, please list.

Is there Additional Information You Would Like to Provide?

Location of Event

Address

City/Town

ZIP/Postal Code

Please inform the role of the Supervisor at the event and what time he is expected to be there for his role (i.e. entire time, specific time?)

Math question 5 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.