Prefix—Please choose an option—Mr.Mrs.Ms.Dr.Mr. & Mrs.
First Name*
Middle Name
Last Name*
Mailing Address*
Mailing Address 2
City*
State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWisconsinWyoming
Zip Code*
Phone*
Email*
Organization/Company
We invite Lt. Governor Bedke to be our*—Please choose an option—GuestSpeakerKeynote SpeakerHonoreeOther
Date & Time*
Location of the event
Description of event
Purpose of Lt. Governor Bedke's involvement Additional information Is press/media involved? In what capacity?
We do not schedule anything more than six weeks in advance. Once we receive your request we will review it at the appropriate time.
Any press releases, sound bytes, printed material, etc. that use Lt. Governor Bedke's name or quotes must be approved by the Office of the Lt. Governor before being distributed. If you are unwilling to do this, the Lt. Governor will be unable to participate in your event. Submission of this form indicates that you understand and accept these terms.
By checking this box, I agree to the above guidelines *
Official Government Website
Official Government Website