Document QBj92m8nqQKE4oJGEL3Epeoo

Event Request Form for Adm inistrator E. Scott Pruitt U.S. Environmental Protection Agency To request the Administrator to attend and/or speak at your event, phase complete and, submit the fo llo w in g form . G roup: Nam e o f Event: D ate o f Event: T yp e o f E vent (banquet, lecture, panel discussion, etc.): R ole o f the A dm inistrator: A pproxim ate tim e will the A dm in istrator's R em arks B egin (exam ple 9:00 am): E xpected length o f the A dm inistrator's rem arks: W ill there be Q&A? If so, for how long and who from ? Ex: press, attendees: Event begins (exam ple 9:00 am): Event ends (exam ple 9:00 am): E v e n t ad d re ss [please include roomname ornumberif applicable): W ill there be a hold room for the A dm inistrator? (please include room name an d/or number): P lease list the name and title o f the individual who will introduce the Adm inistrator: A pproxim ate size o f the audience. Please also include a b rief description o f the m akeup o f the Sierra Club v. EPA 18cv3472 NDCA Tier 7 ED 002061 00111467-00001 au d ien ce {attorneys, business owners, veterans, students etc.)-. P lease indicate your request for the topic o f the A dm inistrator's rem arks, if applicable: P lease list any special guests, elected officials, or other dignitaries who are invited or are expected to attend: P lease list any other speakers at this event: Is this event open to the media?: P lease list a point o f contact for the day o f the event, including a cell phone number and e-m ail address for the contact: I f applicable, please list the nam e(s) and contact inform ation o f the person(s) who will greet the Adm inistrator upon arrival, including a cell phone number and e-m ail address for each contact: P lease list any special inform ation or directions, such as ongoing construction, specific points o f entry, or parking instructions, about the event or location: P lease list below any other relevant inform ation such as agendas, background inform ation or oth er relevan t in fo rm atio n ab o u t th e event. (Information mayalso be attachedandsubmitted with this form.) P lease include a contact number for the event location: P lease indicate whether this event is held weekly, m onthly or annually: P le a se in d icate th e a ttire fo r th is event ( business, formal, casual, etc.): P lease list any agencies, businesses, schools or universities, or other organizations that may be sponsoring or co-sponsoring this event: P lease provide the security contact if contracted or head o f security for event location: Sierra Club v. EPA 18cv3472 NDCA Tier 7 ED 002061 00111467-00002