Appointment Request Form

Department of Energy, Labor and Economic Growth

DELEG | Sitemap | Contact | Online Services | Agencies

If you would prefer to print the form and send by mail or fax, please click here to get the form in PDF format, then print, and send requests to:

Director's Scheduling Office: P.O. Box 30004, Lansing, MI 48909 Scheduling Questions? Email the Scheduling Office.
I.D. Mail: 4th Floor, Ottawa Building, Lansing Run
Fax: 517.373.2129

Event Information (All BOLD fields are required.)

EVENT:			TOPIC: (Please be specific)
DATE OF EVENT: (mm/dd/yyyy)
EVENT DETAILS: (You must choose a beginning and end time for at least one of the three choices.)			LOCATION:
Reception	Begin:	End:	Our Office	Other	If Other:
Meal	Begin:	End:	Our Office	Other	If Other:
Program	Begin:	End:	Our Office	Other	If Other:
EVENT REQUEST: (Check all that apply) Attend Only Keynote Speech Panel Greetings/Comments Meeting Present Proclamation/Grant/Award Representative Desired if Director Unavailable? Other			GENERAL INFORMATION: Questions and Answers Other Speakers? Other Event Details:

Contact Information (All BOLD fields are required.)

REQUESTOR'S NAME:		TITLE:
ORGANIZATION/ASSOCIATION/FIRM/OFFICE:
MAILING ADDRESS:
OFFICE PHONE:	CELL PHONE:	FAX NUMBER:
E-MAIL ADDRESS:		HOME PHONE: (or Other Emergency After-Hours Contact)

Attendee Information (All BOLD fields are required.)

ATTENDEE DESCRIPTION (i.e. Association members, students, general public, seniors, etc.)

NUMBER EXPECTED


Type the characters you see in the picture above.