Mayor's Office for People with Disabilities

Speaker Request Form

Gabe Cazares, Director
Mayor's Office for People with Disabilities
P.O. Box 1562
Houston, TX 77251
Phone Number 832.394.0814

PLEASE NOTE ... Requests must be made 15 days in advance and will only be confirmed by the Mayor's Office for People with Disabilities.

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

Event Location Phone:

Will there be a stage?

Is the stage ramp accessible?

Is there a podium?

What type of mics are available?

Opportunity for the MOPD to staff a resource table at the event?

If yes, please describe your tabling requirements.

Are other City of Houston Officials Invited / Attending? Who?

Type of Presentation:
Topic of Presentation:
Audience Info:
Time of Presentation:
Length of Presentation:
Group Size: