Contact & Event Information

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1. Contact Information of Requester

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2. If you previously submitted an online request, please indicate whether this is an additional request or a revision of your previous request:

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3. Event Title

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4. Event Date
(Requests must be received at least 30 days prior to event date)

Date

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5. Is the date and time of the event flexible?

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6. Provide details for multiple or flexible dates and times:

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7. Event Location:

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8. Event Time (If Set)

Event Start Time
Event End Time
Requested Speaker Start Time

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9. Estimated attendance:

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10. Other Scheduled Speakers:

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11. If you have been in communication with someone at DOJ concerning this request, please provide their name(s):

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12. Is the event open to the public?

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13. Is media coverage expected?

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14. Will the event be taped or broadcast?

T