Indiana Department of Revenue (DOR)
Business Education Outreach Program
Event Request
Please email completed form to: Bizoutreach@dor.IN.gov
Partnering Organization Information
Organization Name:
Contact Person:
Email Address:
Phone Number:
Mailing Address:
Website:
Facebook, Twitter,
LinkedIn, etc.:
Event Request Information
Topic Requested*:
Audience Description:
Estimated
Audience Size:
Presentation Date:
Presentation
Time:
Presentation Length:
Cost for
Attendees:
Speaker Requested:
Previous Speaker
(if applicable):
Presentation Materials
You Will Provide:
Projector
Screen
Computer
Presentation Clicker
How to Register for Event:
(include website URL if applicable)
Presentation Location:
Parking Instructions:
Select if you do not authorize DOR to reference or promote your event in our
external communications, such as our website, social media, newsletter etc.
Additional Information
*A list of available topics can be found at dor.in.gov/5176.htm