Form Center

2. Important scheduling information:
   The First Selectman welcomes your event request at any time; however, our scheduling requires 2 weeks’ advance notice prior to the event date requested. First Selectman’s schedule may change at any time, based on emerging town needs and responsibilities. If last-minute schedule changes occur, we will notify you as soon as possible and attempt to reschedule.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Fax Number
16. Email Address*
18. Organization submitting request:*
19. Organization website:
21. Event title / name:*
23. Event / meeting description: *
25. Event location:*
    -- Select One --Town HallA different location
27. Event / Meeting venue (if not at Town Hall):
29. Address
31. City
32. State
33. Zip Code
35. Event date and time:*
    Event date and time:

    Event date and time:
36. Date First Selectman would attend:*
    Date First Selectman would attend:
37. Is the date flexible?*

    1. Yes
    2. No
39. Time First Selectman would attend:*
    Time First Selectman would attend:
40. Is the time flexible?*

    1. Yes
    2. No
42. How long should the First Selectman plan to speak?*
    -- Select One --15 minutes30 minutes1 hourOther
43. First Selectman role:*
    -- Select One --GuestSpeakerKeynote SpeakerHonoreeOther
45. Has the First Selectman or any member of the Board of Selectmen participated in the past?*

    1. Yes
    2. No
47. Who will be in attendance?*
    Be sure to include any special guests you have invited.
49. Will the media be invited?*

    1. Yes
    2. No
51. List the media that have been invited:
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field