Request for Speaker

If you would like to make a request for the Secretary of State to attend or speak at an event, please fill out the following request form, being sure to fill in each blank of the form.  After you have filled in all of the required * information and clicked on the Submit button, you will receive an e-mail confirming that your request has been received by the Secretary of State's Office.

Please submit your scheduling request for an event that is at least two weeks from today's date. Thank You.

Scheduling Secretary of State Delbert Hosemann
Name: First*   Last*  
City: State Zip
Contact Number: *  
Alternate Number:
Emergency Number:
e-Mail: *    
Name of Event: *  
Requested Date: *  
Expected Attendance:
Speech Start:
Speaking Time:
Speech Topic:
Name of Person
Introducing Secretary:
Other Speakers:
Name of Facility:
Address of Facility:
Additional Information: