Event Participation Form Very Special Name Event Summary Select the requested level of participation that would be most appropriate for this event Select... FRA Administrator FRA Deputy Administrator FRA Associate Administrator, Office of Railroad Safety / Chief Safety Officer FRA Chief Counsel FRA Associate Administrator, Office of Administration FRA Associate Administrator, Office of Railroad Development FRA Associate Administrator, Office of Research, Data, and Innovation FRA Chief Financial Officer Other (specify) Other Requested level If the requested attendee is unable to participate, would you accept a surrogate speaker? Yes No Event Title Meeting Type Meeting Speaking Engagement/Event Participation FRA/DOT-Funded Project-Related Event Other (specify) Other meeting type In Person Virtual Hybrid Recorded Who is organizing the event (inviting organization and/or individual)? Physical Address of the Venue: Street City State Select a state... AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Event start date Event end date Date & Time for FRA participation Provide an agenda for the event. If a final agenda is not yet available, submit a draft Provide the link to the event website, if available Please provide a brief summary of the event including goals Describe the expected audience. (Include the group size and who will be in attendance, i.e., freight industry CEOs/COOs and Government Affairs officials, state transportation officials, etc.) Contact Meeting Contact #1 (POC for the event) Name Title Email Address Cell Phone Number Office Phone Number Meeting Contact #2 Name Title Email Address Cell Phone Number Office Phone Number Content Information Who is the emcee, moderator, or introducer? For panels, have other panelists been identified or confirmed? List the names and titles of any U.S. Department of Transportation representatives who have been invited and/or confirmed to speak at the event Do you expect media to attend this event? Yes (provide your communications or PR representative’s name and email address) No PR Representative/Media Contact Name Email Address Event Format Keynote remarks Panel discussion (provide the names of the other panelists and note if they have confirmed their participation) General remarks Presentation Other (describe) Others Panalists Event Format What is the theme of the event? List 3-5 points, in priority order, that you would like the requested attendee to address during their remarks. Ethical Considerations List any sponsors of the event List any organizations and/or individual federally registered lobbyists who will be in attendance. Will the FRA representative need to pay any registration or other fees (i.e., meals, but excluding travel)? Yes (itemize the fees and their amounts) No Itemize the fees and their amounts Are there any social events as a part of this event, such as happy hours, golf tournaments, tours, etc.? Yes (describe the event(s) and list the fair market value of each) No List additional social events Additional Information Upload any invitations, bios, and/or other supporting documentation Provide any additional information that may be useful in preparation for the event