Document qkj4xv4454oKagdq9406zMLOj

Event Request Form for Administrator E. Scott Pruitt U.S. Environmental Protection Agency To request the Administrator to attend and/or speak at your event, please complete and submit the following form. Group: Name of Event: Date of Event: Type of Event (banquet, lecture, panel discussion, etc.): Role of the Administrator: Approximate time will the Administrator's Remarks Begin (example 9:00 am): Expected length of the Administrator's remarks: Will there be Q&A? If so, for how long and who from? Ex: press, attendees: Event begins (example 9:00 am): Event ends (example 9:00 am): Event address (please include room name or number if applicable): Will there be a hold room for the Administrator? (please include room name and/or number): Please list the name and title of the individual who will introduce the Administrator: Approximate size of the audience. Please also include a brief description of the makeup of the audience (attorneys, business owners, veterans, students etc.): 17cv01906 Sierra Club v. EPA ED_001523B_00002666-00001 Please indicate your request for the topic of the Administrator's remarks, if applicable: Please list any special guests, elected officials, or other dignitaries who are invited or are expected to attend: Please list any other speakers at this event: Is this event open to the media?: Please list a point of contact for the day of the event, including a cell phone number and e-mail address for the contact: If applicable, please list the name(s) and contact information of the person(s) who will greet the Administrator upon arrival, including a cell phone number and e-mail address for each contact: Please list any special information or directions, such as ongoing construction, specific points of entry, or parking instructions, about the event or location: Please list below any other relevant information such as agendas, background information or other relevant information about the event. (Information may also be attached and submitted with this form.) Please include a contact number for the event location: Please indicate whether this event is held weekly, monthly or annually: Please indicate the attire for this event (business, formal, casual, etc.): Please list any agencies, businesses, schools or universities, or other organizations that may be sponsoring or co-sponsoring this event: Please provide the security contact if contracted or head of security for event location: 17cv01906 Sierra Club v. EPA ED_001523B_00002666-00002