MA Schedule Requests

Note: Fields marked with an * are required.

Senator Brown looks forward to visiting with constituents in the Commonwealth. If you have an event or meeting that you would like the Senator to attend, please fill out the following form and the Senator or a member of his staff will get back to you as soon as possible. If you have any questions, please call 617-565-3170.

Request Type *

Meeting

Event/Speaking

Event Information

Duties Requested

Attendance

Remarks

Tour

Expected Attendance?

Request Information

Please indicate if this is a request for a member of my staff *

Yes

No

Name of Group/Organization *

Description of Group/Organization *

150 character limit

Purpose for Meeting/Event *

Please provide the specific issues you wish to discuss.
150 Character limit

Massachusetts Connection (Are you a current or former Massachusetts resident, or company or organization based in Massachusetts? Briefly explain) *

Will the Senator be asked to speak? If the answer is yes, please answer a), b), and c) below. Otherwise, move on to the next section. *

Yes

No

a) For how long is he being asked to speak (up to 15 minutes)?

b) What is the topic?

c) Will there be Q and A?

Yes

No

Contact Information

Prefix

First Name Of Person Organizing Meeting/Event *

Last Name *

Address 1 *

Address 2

City *

State * ----Military---- AA AE AP ----States---- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Phone *

Contact Number on the Day of Your Meeting (mobile) *

Email *

Scheduling Information

Available Date(s) of Meeting/Event *

Please provide the specific dates as open ended requests may not be considered. Dates must be in the format yyyy/mm/dd. Events lasting several days must be separated by commas (ex. 2010/01/10, 2010/01/11).

Time of Event or Availability for a Meeting *

Location *

Names and Positions of Participants *

Is this event open to the Press? *

Yes

No

Any Additional Information

500 character limit