Schedule An Event

Thank you for your interest in inviting me to an event. Please use this form to schedule an appointment in my office or for my attendance at the event. Complete the form below, fields marked with an (*) are required. A staff member will be in contact soon.

"*" indicates required fields

Contact Information

First Name*

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Point of Contact

Contact for Meeting*

Title*

Email*

Cell Phone Number*

Event Information

Event Name

Event Date*

Program Begins*

Program Ends*

Who Is The Sponsor/Host Of The Event?*

Event Format (reception, seated dinner, awards ceremony, etc)*

Where Will The Event Contact Greet The Senator On Arrival?*

Event Location*

Street Address Address Line 2 City State ZIP Code

Brief Description of Event

Photo & Bio Needed?

Photo

Bio

Speaking Details

Number/Description of Audience

Introduced By

Speaking Order/Participants

Q and A

Podium

Microphone

Hold Space

Will the remarks be videotaped or posted on the organization's website?

Press

Press Description (Type N/A if you selected 'No' above)

Attire

Organization Details

Background on Organization

Org Website