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CALIFORNIA ENVIRONMENTAL PROTECTION AGENCY

MEETING SCHEDULE REQUEST FORM

Office of the Secretary

* These fields are required

Requestor's Name: *

Email: *

Phone Number:

Meeting Requested From: *

Internal Department or Personnel
External Agency or Individual

Meeting with:

Program: *

Boards/Departments/Offices:

Meeting Subject and Clear Description of Request:

Expected Outcome:

Additional Background Information:

Need Meeting By:

Level: *

Proposed Meeting Dates and time (1):

Date

Time

Proposed Meeting Dates and Time (2):

Date

Time

Meeting to include International Visitors?:

Meeting Type:

Mtg Location:

Duration:

Recurring:

(1) Attendees Name:

Required
Optional

(2) Attendees Name:

Required
Optional

(3) Attendees Name:

Required
Optional

(4) Attendees Name:

Required
Optional

(5) Attendees Name:

Required
Optional

(6) Attendees Name:

Required
Optional

Additional attendees:

Additional attendees

Additional attendees: *

Attachments:

Yes
No

Please email any attachments to cepacomm@calepa.ca.gov

Projector:

Yes
No

Laptop:

Yes
No

Address

Address Line 1

Address Line 2

City

State

Zip Code