JimJordan

First Name Last Name Email Address

Meeting Request

If you are interested in meeting with me or my staff, please note that this request form is only for meetings in my DC office.

Name:

* Prefix	* First Name	* Last Name

* Address:

* City:

* State:

* Zip:

* Point of contact:

* Phone:

* Email:

Desired meeting location:

Will anyone from Ohio's 4th Congressional District be attending this meeting?

Yes No

If so who?

What is your connection with Ohio?:

Which issue/area of specialty does this meeting concern:

Are you 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:

WASHINGTON, DC OFFICE
515 Cannon House Office Bldg Washington, D.C. 20515 T (202) 225-2676 F (202) 226-0577
MANSFIELD OFFICE
24 West Third Street, Room 314 Mansfield, OH 44902 T (419) 522-5757 F (419) 525-2805
LIMA OFFICE
3121 West Elm Plaza Lima, OH 45805 T (419) 999-6455 F (419) 999-4238
FINDLAY OFFICE
100 East Main Cross, Suite 201 Findlay, OH 45840 T (419) 423-3210 F (419) 423-3233