Document gbxx8M1B4ybdkNmv4geO6MJL9

Document 109 - Attachment 1 Event Information Request Form Thank you for your interest in hosting the U.S. Deputy Secretary of Energy at your event. To ensure that the appropriate individual within the Department ofEnergy is participating in your event and because the Office of the Deputy Secretary is committed to maintaining the highest ethical standards, we need the infonnation requested below before we can agree to confirm a speaker. Please respond to the questions below and send your response to Starlette.Gibbs@hq.doe.gov. If you have any questions you may contact the Deputy Secretary's Scheduling Office at 202-287-1 856. Title of the Event (please note if the event is a weekly, monthly, annual, etc.): Date of Event (please note if the date is flexjble): v \ Event Location (venue, address, city and state/country): Point(s) of Contact (Name, Email, Phone): - -- .... Briefly describe the event in detail includi ng the V purpose and desired role ofthe Deputy Secretary (i.e. deliver keynote remarks, attend an event, meet with attendees etc.): Is the event a fundraiser? lfyes, please explain who it is benefiting (i.e. specific charity, a political candidate, etc.): Audience Approximately how many people are expected to attend the event? Please describe the target audience of the event (elected officials, local community leaders, academics, industry representatives, public sector representatives, etc.). Will the attendees at the event include persons with a diversity of views or interests, or representatives from throughout an industry or profession, or the range of persons interested in a matter? (If yes, please describe.) Sierra Club v. Dept of Energy, 4:25-cv-5027 SC_EVERSPLIT0027437 Is the event open to the public (this includes ticketed individuals)? If not, please describe who is privately invited. Who are other VIPs or speakers confirmed and in what role? Who are other VIPs or speakers invited? Remarks If you are requesting remarks, are there any specific issues you would like the Deputy Secretary to highlight/address in bis remarks? What is the desired format of his remarks (will he be delivering the keynote, sharing the stage, participating in a panel or rotmdtable, etc.)? What is the public registration/ticket fee to attend/participate in the event? Will there be a teleprompter available? Will there be a podium? Communications/Press Is the event open or closed to press? If open, are you expecting local, state, or national news coverage? If this is an annual event, which news outlets typically cover the event? Will you be adve11ising or live streaming the event on any social media outlets or websites? (If yes, please explain.) Logistics/Other* If this invitation includes any gifts to the Deputy Secretary (e.g., waived registration/conference event fee; meals or refreshments; receptions or other entertainment; infom1ational mate1ials; award; transportation; memento or token of appreciation), please identify them and provide their monetary value. Please also identify how the value was determined. (Please attach separate sheet if necessary.) Does the invitation extend to the Deputy Secretary's spouse or other guest? If ves, will - ..... ; Sierra Club v. Dept of Energy, 4:25-cv-5027 SC_EVERSPLIT0027438 others in attendance general!y be accompanied by a spouse or other guest? Will the Deputy Secretary be asked to sign a speaking/participation agreement or release related to this event? If so, please provide a coov. If the Deputy Secretary is not able to attend, is a surrogate desired? If yes, anyone specific? Any additional notes or information? Event Host and Sponsor Who is the event host? (Please identify and provide background on the Event host as well as any other organization involved in the Event.) \ Event host website/url. :, Is the event host a registered lobbyist or lobbying organization, and/or registered under the Foreign Agents Registration Act? (If yes, please identify.) Is the event host a partisan political candidate, a representative of a political pa1iy or a registered political action committee (PAC)? (If yes, please identify.) Is the event host a 501(c)(3) organization or a media organization? (If yes, please identify.) Is the event host seeking or cmTently have any business interests with the Department such as permits, contracts, litigation, grants, etc.? (If yes, please describe.) Who are the sponsors of the event? Please identify and provide background information on the individual and/or entity. Are any event sponsors seeking or do they currently have any business interests with the Department such as permits, contracts, litigation, grants, etc.? (If yes, please describe.) With which Bureau or Agency does your agenda most align? Please list all, if more than one. Partisan Political Candidate or Elected Official Participation Sierra Club v. Dept of Energy, 4:25-cv-5027 SC_EVERSPLIT0027439 Will any partisan political candidate or elected official participate in the event? Ifso, please identify and explain role. Is the coordination of any elected official's involvement being handled solely by their official staff, or is there any campaign staff involvement or coordination? Ifa candidate for office or elected official is participating in the event, is the event taking place in their respective district/jurisdiction, and will the entire delegation for the respective dishict/jurisdiction(s) been invited? If not, please explain. *IMPORTANT NOTE: The purpose ofthese questions is to elicit information relevant to the ethics analysis and is not a solicitatio11 or re uest or a11 thin o vallle b the De art111e11t or a11 o us em lo ees. Sierra Club v. Dept of Energy, 4:25-cv-5027 SC_EVERSPLIT0027440