Mayor’s Office of Gang Prevention and Intervention

Speaker Request Form

Victor M. Gonzalez, Jr., Division Manager
Mayor’s Office of Gang Prevention and Intervention
Department of Neighborhoods
P.O. Box 1562
Houston, TX 77251
Phone Number 832.393.0931

PLEASE NOTE ... Requests must be made 30 days in advance and will only be confirmed by MOGPI.

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

Include building, floor/room #, and parking instructions


Directions from downtown:

Event Location Phone:
Topic of Speech:
Audience Info:
Time of Speech:
Length of Speech:
Group Size: