Mayor Daley's Bicycling Ambassadors

Richard M. Daley, Mayor City of Chicago Seal

Request Form

Event:

Date of Event (mm/dd/yy):

Address:

Ward: Police District #:

Start Time: End Time: Rain Date (mm/dd/yy):

How did you learn about us?

Have you done this event before? Yes No

Did you issue a press release for this event? Yes No

Goals/message at the event:

Ambassadors should focus on:

adult bicycling safety
helmet fitting
commuting, shopping and/or carryingby bike
child bicycling safety
motorists share the road with bikers
bus-rack demonstration

Ambassadors are requested to do:
display presentation (length: minutes) news media interview

Have people been encouraged to bring their bicycles to the event? Yes No

What non-English languages will peoplespeak at this event?
Spanish Polish Korean Chinese
Other

PRIMARY CONTACT INFO:

ON-SITECONTACT FOR EVENT:

Organization:

Name:

Phone:

Fax:

Address:

Zip:

E-mail:

Organization:

Name:

Phone:

Fax:

Address:

Zip:

E-mail:

Ages:
1-5 6-8 9-11 12-17 18-24 25-30 31-65 66+

No. of people expected:

Ifthis is a children's event, how will they arrive?

Others attending:

Gov't Officials	No Yes	Who:
Police Units	No Yes	Who:
News Media	No Yes	Who:
Sponsors:	No Yes	Who:
Other:

SITE: Indoor Outdoor

If outdoor: on grass under tent on pavement on dirt

You will supply the Ambassadors:
a table chairs other no equipment

If the Ambassadors are assigned a booth or location number, enter here

Event Agenda - Will there be:

Presentations:	No Yes If yes, describe:
Entertainment:	No Yes If yes, describe:
Items for sale:	No Yes If yes, describe:
Give aways:	No Yes If yes, describe:

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