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Mayor's Anti-Gang Office

Speaker Request Form

Patricia Harrington, Division Manager
Anti-Gang Office
Department of Neighborhoods
P.O. Box 1562
Houston, TX 77251
Phone Number 832.393.0931
Email: patricia.harrington@houstontx.gov

PLEASE NOTE ... Requests must be made 30 days in advance and will only be confirmed by the Mayor's Anti-Gang Office.

  ORGANIZATION
   
Org Name:
Org Address 1:
Org Address 2:
Org City:
Org State:
Org ZIP:
Org Phone:
Org FAX:
Org Website:
   
  CONTACT
   
Contact Name:
Contact Address 1:
Contact Address 2:
Contact City:
Contact State:
Contact ZIP:
Contact Phone:
Contact FAX:
Contact E-Mail:
   
  EVENT INFORMATION
   
Event Type:
Event Date:
Day of Week:
Time:
Alt. Dates?:
Event Address:

Include building, floor/room #, and parking instructions

 

Directions from downtown:
 
Event Location Phone:
   
  SPEECH INFORMATION
   
Topic of Speech:
Audience Info:
Time of Speech:
Length of Speech:
Group Size: