Please fill this form to request the presence of the Commission on Black Women and Girls at your event. Please ensure this form is submitted at least 4 weeks in advance of the event. Subject to the availability of the Commission members. Requestor information Information Title Title - None -MissMsMrMrsDrOther… Enter other… First Middle Last Suffix Email Address Event Information Organization Name When does the event take place? Is this event virtual or in-person? - Select -VirtualIn-Person Specify the location of this event, including the address. (Type "Virtual" if applicable) Address City/Town ZIP/Postal Code What is the name of the event? Provide a brief overview of the event. Are you requesting the presence of the body of the Commission or a specific member? - Select -Body of the CommissionSpecific member(s) of the Commission Please list the member(s) of the Commission you are requesting for. What is your specific ask of the Commission member(s)? Please specify what exactly you would like them to speak on and the overall goal you would like to achieve by having the Commission member(s) present. How many people do you anticipate attending the event? - Select -Less than 50 attendees50-100 attendeesOver 100 attendees Upload any flyers, briefs, or information pertinent to the attendance of the Commission member(s). One file only.10 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, avi, mov, mp3, mp4, ogg, wav. Leave this field blank