Form Center

2. Thank you for your interest in having Mayor Mark Holm attend your event!

   Please read the following instructions prior to submitting your request:

   • Please provide complete, detailed information in the form below.
   • Please submit your request at least 30 days prior to your event.
   • Please do not publicize (invitations, agendas, etc.) that the Mayor will attend your event until you have received written approval from the Ankeny City Clerk's Office.
4. Your Full Name*
6. Organization (if applicable)
8. Phone Number*
9. Email Address*
11. Event Date*
    Event Date
12. Event Start & End Times*
    Event Start & End Times
14. Event Information*
16. Event Location
18. Address
20. City
21. State
22. Zip Code
24. Number of Attendees*
26. Who is in the audience?*
28. Relevant Event Details*

    Please include agenda, run of the show, and background if applicable.

30. Would you like the Mayor to speak at your event?
    -- Select One --2-3 Minutes of Remarks5 Minutes of Remarks10+ Minutes of RemarksPanelAttending Without Remarks
32. Is the Mayor receiving an award?*
34. Additional Comments or Information
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field