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
Email: jacqueline.gonzalez@houstontx.gov

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

  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: