Document ZB1Lw1mj8wkVq5wRmXQneQK5L

ADMINISTRATOR SCOTT PRUITT EVENT REQUEST FORM U.S. Environmental Protection Agency Deadline for Acceptance: Requesting Individual/ Affiliation: Event Title: Event Date: Is the Above Date Flexible: Event Time & Duration: Type of Event: Purpose of the Event: Role of the Administrator: Requested Presentation Topic, if Speaking Involved: Requested Presentation Format: Speech/Presentation Duration: Would You Consider a Surrogate: Event Location: Event Audience: Event Host(s)/Organizer(s): NIA Society oflndependent Gasoline Marketers of America (SIGMA) SIGMA Annual Conference November 8, 2017 2.00 pm - Reception with Board Members from SIGMA and NATSO 3.00pm-4.30pm Opening General Session (details below under flow/agenda) 6.00 pm - 7.30pm Invited to the SIGMA Welcome Reception for the Conference at the Museum of Contemporary Art - obligated Annual Conference Brief Description Speaking Engagement in conversation with Brad Puryear, General Counsel for Mansfield Energy and SIGMA's 1st Vice President & Chairman of SIGMA Legislative Committee The Current State of the EPA and the Effects on the Fuels Industry "Fireside Chat" style conversation (if needed, PowerPoint is available, not required) 45 - 60 minutes The Westin Michigan Avenue 909 North Michigan Avenue, Chicago, IL 60611 312.943.7200 (main line) Great Lakes Ballroom, (Level 2) Approximately 300, SIGMA Annual Conference Attendees - industry focused audience. SIGMA 17cv01906 Sierra Club v. EPA Page 1 of 3 ED_001523B_00000587-00001 HoSt(s)' Re~tnWfl'NiTRATOR sc0Wi1ftir1TT EVENT REQUEST FOR1'f U.S. Environmental Protection Agency Run of Show/ Agenda: 3.00 pm-opening remarks and self-introductions of SIGMA members in the room Approx. 3.25 pm - introduction of Administrator by Brad Puryear; Brad will welcome the Administrator to the stage Approx. 3.25 pm -4.20 pm - time available for on stage conversation (this includes any Q&A time and is approximate; it can go shorter based on the Administrator's preference) 4.25 pm - closing remarks 4.30pm-end Further detailed information will be sent as small details are _co_n~ifi_zr_m_e_d_._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Is there a Hold Room Available for the Administrator? Yes - details confirmed through Cheryll Decker, Director of Meetings _SI_G_M_A~,_7_03_._3_75_._04_8_1_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Open Press/Closed Press? Open to Selected Press - we can provide a list of those attending (only press that is registered through SIGMA can attend or those you request _to_b_e_g_i_v_en_a_cc_e_s_s)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Dress Code: Teleprompter Available: -B-usi-nes-s - - - - - - - - - - - - - - - - - - - - - - _N_o_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Microphone/ Room Setup: Lavalier/Lapel mic; Room diagram attached for setup of Great Lakes Ballroom (both diagram and birds eye view) Honorable Guests Attending: SIGMA & NATSO Board Members, Owners and CEOs of petroleum _m_ar_k_e_ti_n~g_c_o_m_p_an_ie_s_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Notable Federal, State or Local Appointed or None Elected officials attending: Individual Introducing Administrator: Dave Baker, President of SIGMA and/or Brad Puryear (Brad will be the one joining the Administrator on stage) Person to contact for media purposes: Amy Rider, Director of Communications, 703.375.0485, 703.517.3171 Is this event held Weekly, Monthly, Annually? Annually Day of Event Point of Contact: Liz Menz, Director of Education, SIGMA, 703.375.0483, 314.616.3907 Secondary: Cheryll Decker, Director of Meetings, SIGMA 703.375.0481, 571.235.7490 Security Contact: Nicole Spranger, Meeting & Event Manager, The Westin Michican Avenue - 312.649.7456 Suggested Entrance/ Exit to Event Venue: Please Contact Nicole Spranger for best entrance/exit information at the venue Page 2of 3 17cv01906 Sierra Club v. EPA ED_001523B_00000587-00002 Is the host o.f \l\ll\t;f-f;fltM~WqqI}OU_cL(}}-,0 (4), or has ~t,1-N,-fiti\:M'~to\&AliriU.., (PAC): U.S. Enviro-N~ o, S-IG- MA-i- s a-50~ l(c)~ 6 - - - - - - - - - - - - - - - - Will there be a "gift" presented to the Administrator? If so, what is the US currency value of the gift? No Will a meal be provided, if so what is the US currency value? No Please return this form completed to scheduhng(ii1epa.gov and Aaron Dickerson at dickerson.aaron(a'1ez a.gov 17cv01906 Sierra Club v. EPA Page3 of 3 ED_001523B_00000587-00003