Request Presence of Your Elected Official

Last modified: 3/9/2012 10:45 AM

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Please use this form to request the presence of your Elected Official at an event.

* Indicates a required field.

Which Elected Official would you like to attend the event? *

Do you want the Official to speak at the event?

YesNo*

Attire *

Contact Information

Requested By *

Title *

Organization Name *

Contact Person *

Contact Phone Number *e.g. 408-444-5555

Contact Email *

Event Information

Date of Event *e.g. 02/16/2012

Type of Event *

Topic *

Materials Requested

Event Start Time *e.g. 9:30 am

Event End Time *e.g. 10:30 am

Location Address *e.g. 58 Main St., Room 132

City *e.g. San Jose

Phone Number at Event *e.g. 408-333-5555

Description of Audience *

Estimated Turnout *

Media Invited *

Additional information or comments

Please contact me via

PhoneEmail*

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Your Name

Detailed description of problem(s) *

E-mail address

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