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SPEECH REQUEST FORM FOR TAX ASSESSOR-COLLECTOR SYLVIA ROMO
Date of Request:______________Date/Day of Speech:___________Time of Speech:________
Contact:_________________________________________Phone:_____________________
Organization: _______________________________________________________________
Address: __________________________________________________________________
Type/Meeting: __________________Type/Audience: ___________Number Attending: _____
Length of Speech: __________________________________________ Q&A: ____________
TOPIC/ISSUES OF INTEREST TO GROUP: _________________________________________
__________________________________________________________________________
Other Speakers/Dignitaries:_____________________________________________________
Location: _________________________________________ Dress/Attire: _______________
Other: ____________________________________________________________________
Comments:_________________________________________________________________
__________________________________________________________________________
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FOR TAX OFFICE USE ONLY
Confirmed by: _____________________________________ Date: _______________________
Bio Provided: __________________________________Photo Provided: __________________ | 
