Scheduling Form Print

If you are interested in meeting with Congressman Scott or inviting him to attend or speak at an event in the 3rd Congressional District of Virginia, or elswhere, please complete the following form (*required):

Primary Point of Contact*:
Organization:
Address:
City: ,
State: Zip*:
E-Mail*:
Daytime Phone Number*:
After Hours Phone Number:
Date of Event/Meeting*:
Event Type:
Event Theme/Meeting Subject:
Event Location:
Time*:

Attire:

Rep. Scott's Role:
Agenda:
Length of Speech, if speaking:
Topic of Speech:
Estimated Number of People Attending:
Description of Audience:
Name of Event Coordinator:
Contact Name/Number at Event:
Elected Officials Attending (if any):
Media Coverage
(Y or N):

 

Comments:

 
 

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