Document KGKjpE8R4ppJ6dbZBk7YR3ar

To: butler@spn.org[butler@spn.org] From: Hupp, Millan Sent: Sat 3/25/2017 4:32:07 PM Subject: EPA Administrator Request Form - SPN EPA Administrator Pruitt Speaker Request Form.docx 0001.txt Jennifer - kindly complete the attached. 17cv1906 Sierra Club v. EPA ED_001523B_00003519-00001 ADMINISTRATOR PRUITT SPEAKER REQUEST FORM U.S. Environmental Protection Agency Deadline for Acceptance: [Publication or otherwise; please see details below] Event Title: [Enter Here] Speech Date: Is the Above Date Flexible: Speech Time & Duration: Speaker Requested: [Day of the Week, Month Date, Year] [Yes/No] [#:##am/pm- ##:##am/pm] Administrator Scott Pruitt Would You Consider a Surrogate: Event Location: [Yes/No] [Location Name] [Street Address, City, State, Zip] [Location Telephone Number] [Room Name/Number] Open Press/Closed Press: [ Open/Closed/TBD] Is Event Webcast/Recorded/Transcribed: [Yes/No] [If Yes, please specify] Purpose of the Event: [Enter Brief Description] Speech Topic: [Topic] Requested Presentation Format: [Keynote, Panel, Q&A, Introduction] Dress Code: Speech/Presentation Duration: [Casual/Business/Black Tie Optional/Black Tie/Other] [Length of Remarks] Teleprompter Available: [Yes or No] Microphone / Room Setup: Event Sponsor: Relationship to the EPA: [What kind of microphone will be used? What is the room setup?] [List all Sponsors] [Enter Here] Event Agenda/Program: [Time: Program/Agenda Item] [Time: Program/Agenda Item] [Time: Program/Agenda Item] [Time: Program/Agenda Item] Honorable Guests Attending: [Name/Title] Notable Federal, State or Local Appointed or Elected officials attending: [Name/Title] Individual Introducing Administrator: [Name/Title] Page 1 of 2 17cv1906 Sierra Club v. EPA ED_001523B_00003521-00001