Mayor Request Form

Contact Information

Contact Name(Required)

Organization(Required)

Description of Organization(Required)

Organization's Website Address

Contact Phone Number(s)(Required)

Type of Request

Proclamation Request

Event Attendance

Eagle Scout Recognition

Meeting with Mayor

Other

Event Information

Event Name(Required)

Event Date(Required)

Start Time(Required)

End Time(Required)

Event Location(Required)

Street Address Room/Floor/Location City

Site Contact Information(Required)

Name and cell phone number of on-site contact at the time of the event.

Additional Directions to the Site Location (as needed)

Parking Directions

Information about necessary parking permits or a reserved parking spot for the Mayor.

Event Details

Mayor's Requested Role in the Event(Required)

Is the Mayor being asked to make welcoming statements at an event, give a short speech, or introduce others? If this request is on the behalf of someone else, (i.e. Proclamation), what is that person's name?

Type of Presentation(Required)

Short Speech

Attend Event (no speech)

Panel Discussion

Proclamation

Other

Topic/Purpose of Mayor's Speech

If the Mayor is unavailable, is a substitute representative acceptable?(Required)

Yes

Proclamation Request

What is the topic of the requested Proclamation?(Required)

What is it about your topic that you want to see proclaimed in the City of Champaign?(Required)

Tell us about what makes your subject great! Please be as detailed as possible. If you have a suggested (pre-written) Proclamation for the Mayor to consider, please indicate that here then email it to [email protected].

Where would you prefer to have the Proclamation presented?(Required)

A City Council meeting

At a Specific Event

Other

What is the preferred timing of the requested Proclamation?

If you wish to highlight a specific date, week, or month, please explain.

Will this be a joint Proclamation with the City of Urbana?(Required)

Yes

Eagle Scout Recognition

Name of the Eagle Scout(Required)

Troop Number(Required)

Special Honors

Date of Rank Promotion

Meeting with Mayor

Name(s) of Attendee(s)(Required)

Meeting Topic(Required)

If the Mayor is unavailable to meet with you promptly, will you accept a substitute representative from the City?(Required)

Yes

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Comments

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City Council