Mayor Request Form

Contact Information
Contact Name*
Organization*
Description of Organization*
Organization's Website Address
Contact Phone Number(s)*
Email
Type of Request
- Proclamation Request
- Event Attendance
- Eagle Scout Recognition
- Meeting with Mayor
CAPTCHA

Event Information
Event Name*
Event Date*
MM slash DD slash YYYY
Start Time*

: Hours

Minutes

AM/PM
End Time*

:

AM/PM
Event Location*
Street Address Room/Floor/Location City
Site Contact Information*

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*
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*
- Short Speech
- Attend Event (no speech)
- Panel Discussion
- Proclamation
Topic/Purpose of Mayor's Speech
If the Mayor is unavailable, is a substitute representative acceptable?*
- Yes
- No

Proclamation Request
What is the topic of the requested Proclamation?*
What is it about your topic that you want to see proclaimed in the City of Champaign?*
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?*
- A City Council meeting
- At a Specific Event
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?*
- Yes
- No

Meeting with Mayor
Name(s) of Attendee(s)*
Meeting Topic*
If the Mayor is unavailable to meet with you promptly, will you accept a substitute representative from the City?*
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

City Council