Contact Information

First Name *

Last Name *

Organization

Address Line 1

Address Line 2

City

State

Zip

Phone *

Email *

Event Details

We invite Governor Kitzhaber to be our:
Guest Panelist Keynote Speaker

Date/time of event *

Topic

Will there be a microphone?
Yes No

Will there be a podium?
Yes No

Will would you like time for questions?
Yes No

Who else is speaking?

Location of Event
Street Address

City

Who will be in attendance? (Be sure to include any special guests you have invited, as well as an approximate head count)

Will the media be invited?
Yes No

Has the Governor participated in the past?
Yes No

Additional Information