Contact
Information-
Full Name:
Email Address:
Address:
City/State/Zip:
Phone Number:
Cell Phone Number:
Event Date and Time:
Location of Event (Exact location, room number, etc.):
Meeting or Event Information:
Name of All Attendees:
Reason for Meeting:
How long will meeting last?
o 15
minutes
o 30 minutes
o 1 hour
o Other Please indicate time.
Organization Hosting Event:
Total
Time Requested (Program time, Mayor’s anticipated time of arrival,
amount of time
Mayor is requested to attend):
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City of Helena
Mayor Collins
Schedule Request Form
Mayor’s
Role
o Emcee
o Welcome
o Panelist
o Other
Please indicate role:
Will
the Mayor be asked to speak?
o Yes
o No
Background/Briefing/Details
Please include briefing papers, background information, agenda,
speaking points, or indicate the day the material will be provided at least seven working days in
advance of the event. Materials may also be submitted to the Mayor’s Office (address below):
Mi
leage If Mayor Collins uses personal vehicle for events outside of Helena there is a $.58 cents
per mile (IRS Standard) reimbursement:
Accommodations
- If schedule request requires an overnight stay, please indicate if Mayor Collins’
accommodations will be paid for and name/address of Hotel.
Airfare
If appropriate, please indicate if Mayor Collins’ airfare will be paid for and if he needs to
make his flight reservations.
Please allow seven working days to process and respond to your request.
Mayor Wilmot Collins
City of Helena
316 N. Park Avenue
Helena MT 59623
MAYOR’S OFFICE USE:
Date Confirmed:
By:
City of Helena
Mayor Collins
Schedule Request Form