Schedule a Meeting

Name:

* Prefix	* First Name	* Last Name

* Address:

* City:

* State:

* Zip:

* Point of contact:

* Phone:

* Email:

Desired meeting location:

DC District

Attendees from New York’s
20th Congressional District

Yes No

If so, List

Your connection
with New York:

Issue/Area of specialty
this meeting concerns:

Seeking meeting with the Congressman,
one of his staffers, or either:

Preferred date/time:

Alternate date/time:

PURPOSE of meeting including
any specific BILL NUMBERS: