Request for Appearance by First Lady Kathryn Burgum

Medium

The First Lady is considering requests related to her initiatives that include eliminating the stigma surrounding the disease of addiction, embedding recovery support in communities, tribal engagement and youth engagement.

When completing the form below, please include a description of the audience (roles, demographics, etc.) in the "Additional Comments" section.

NOTE: The First Lady will not be considering requests May - August.

Organizational Information

Organization Making Request

Organization Address

Contact Information

Point of Contact

Contact Phone

Contact Cell Phone

Contact Email Address

Event Information

Name of Event

Event Date

Event Start Time

Event End Time

Time First Lady to Speak

Event Location

Event Address

Media Expected

Yes

Expected Number of Attendees

First Lady's Role at Event

Event and Background Information

Dignitaries or Speakers Confirmed

Additional Comments

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.