Request for Official Duties

Please complete this form to request the Mayor, Councillors or CEO to undertake official duties at an event or function.

Questions? Phone Mayoral and Councillor Support 5128 6154 or email councilsupport@latrobe.vic.gov.au

Request

Name: * (required)

Email:

Contact phone number: * (required)

Who are you requesting? * (required)

Mayor
Councillor
CEO

Event Information

Name of the event: * (required)

Event date: * (required)Event date: * (required)

Event time: * (required)

Event description:

Event contact (if different from above): * (required)

Contact phone number (if different from above): * (required)

Information for mayor/councillors/CEO

Arrival time: * (required)

Departure time: * (required)

Venue/location: * (required)

Dress code: * (required)

Please provide contact name and mobile number for on the day, and where to meet: * (required)

What is the expected role of the requested guest: * (required)

Speech required?

Yes
No

Please upload agenda

Speech requirements

Length of speech, (time allocated):

Please list the order of all speakers at your event.

Estimated number of attendees:

Please list any significant guests or groups represented:

What is Latrobe City Council’s involvement with your event:

What is the purpose of your event? This will inform the key messages of the speech:

Are there any potential issues which may be raised at your event:

Background information or other relevant information to inform the content of the speech:

Upload additional information:

YesNot really

Do you want to do more online?

Fields marked with * must be completed

Your name

Your email address

What do you want to do online? *

Your feedback *

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