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House of Representatives Seal Congressional Hispanic Caucus

Event Request Form

Please note: While Congresswoman Napolitano and her staff make every effort to meet with constituents of California's 38th Congressional District and other groups, due to time constraints this is not always possible. This completed form needs to be received at least four weeks prior to the date requested before we can schedule any events. This form does not serve as a confirmation of the Congresswoman's participation. Someone from our office will contact you directly regarding the status of your request.

* indicates required fields

Name of Person Requesting Event*
Organization*
Type of Event*: (Please Check One)


Other:
Event Date(s)*:
Must enter at least 1 date

Event Times*: From: To:
Time Requested of Rep. Napolitano*: From: To:
Event Location*:


Desired Role of Rep. Napolitnao*:
Purpose of Event*:
Number of Attendees Expected*:
Will Media be Present*:


If Yes, who:

Is the Congresswoman being asked to speak*:


If yes, for how long:

What specifically will she be asked to speak about:
How does this issue relate to California's 38th District
Will there be a Q & A*:


Will there be a microphone/podium*
Who else is speaking/organization:
Will the Congresswoman be introduced*


If yes, by whom:

Contact for the Day of the Event:
Name*
Organization/Title*
Phone(mobile)*
Email Address*
   
 
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Washington, DC Office
1610 Longworth Bldg
Washington, DC 20515
Phone: 202-225-5256
Fax: 202-225-0027
District Office
11627 East Telegraph Road, #100
Santa Fe Springs, CA 90670
Phone: 562-801-2134
Fax: 562-949-9144