ARIZONA DEPARTMENT OF HOUSING
Speaker Scheduling Form
1110 West Washington, Suite 280 Phoenix, AZ 85007
(602) 771-1000
FAX (602) 771-1002
www.azhousing.gov
J://Admin/GRC.Speaker_Scheduling_Form.doc
Use Tab Key to navigate from one field to the next.
When completed, “SAVE” and send or print the saved file.
This form is used for scheduling purposes only. Completion and submittal of this request does not guarantee
ADOH staff attendance at your meeting/event. Once the request has been approved, you will be required to
complete a comprehensive Speaker Confirmation Form. NOTE: WE CANNOT COMMIT TIME MORE THAN
SIX WEEKS IN ADVANCE FOR THE AGENCY’S DIRECTOR.
To expedite your request, complete the form, save as an attachment, and e-mail it to the ADOH Public
Information Officer, or fax it to (602) 771-1002. Questions regarding this form should be directed to the Public
Information Officer at (602) 771-1000.
Speaker requested, if known
Date of event Time of event
Event name
Briefly describe purpose of event
Level of participation KEYNOTE WELCOME PANEL
OTHER Describe
Location of event
Primary contact person
Organization/Business
Address
Phone number FAX number E-mail
Expected attendance #
Who will be there?
Please include a draft agenda/itinerary and a copy of event program, if available.
