Document mpv25gxBK5BgEa11dQZ4q46y4

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): Host(s)' Relationship to EPA: Run of Show/ Agenda: Is there a Hold Room Available for the Candice Boyer, Americans for Tax Reform Wednesday Meeting 9/11/2017 Yes JOa,n -11:30am (The Administrator does not need to stay the whole time.) Meetin Weekly, offthe record, 150 conservative think tanks and activists 3-5min presentation, Possible questions from group (we have 25 presentations total) These presentations are short and pretty rapid fire Absolutely no more than 5 min. Yes, but we prefer the Administator Americans for Tax Reform, 722 12th Street, NW 6th floor 150 List all hosts organizing the event Agenda is offthe record, happy to discuss via phone es 17cv01906 Sierra Club v. EPA Page 1 of 2 ED_001523B_00000707-00001 Administrator? OpenPress~JMWeJ~TRATOR S~O'UJ1hfl-\bV'J' E~EN! REQUEST FORM U.S. Enviro Dress Code: Business Teleprompter Available: Microphone/ Room Setup: Hand held mic Honorable Guests Attending: Will update you day before Notable Federal, State or Local Appointed or Elected officials attending: Individual Introducing Administrator: Tim Jones, Former Speaker ofMO House Person to contact for media purposes: John Kartch, ATR Commination 's Is this event held Weekly, Monthly, Annually? Each week Day of Event Point of Contact: Name & Title; Email; Office Number, Cell Number Security Contact: Name & Title; Email; Office Number, Cell Number Suggested Entrance/ Exit to Event Venue: Front or back door~your choice Is the host of the event a registered 501(c)(3), (4), or has a 527 Political Action Committee (PAC): ~e_s_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Will there be a "gift" presented to the Administrator? If so, what is the US currency value of the gift? _n_o_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Will a meal be provided, if so what is the US currency value? No~there are coffee and donuts. Please return this form completed to scheduhng(ii1epa.gov and Aaron Dickerson at dickerson.aaron(a'1ez a.gov 17cv01906 Sierra Club v. EPA Page 2of 2 ED_001523B_00000707-00002