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Schedule a meeting in D.C. Form

Please use this form only If you want to schedule an appointment in Washington, D.C. For appointments in Las Vegas please call 702-220-9823.

Primary Attendee:

Name:

Prefix: First: Last:

Title:

Organization or Business Name:

Website:

Address (of Primary Attendee):

Business:
	Street:
	City:
	State:
	Zip:

Home:
	Street:
	City:
	State:
	Zip:

	Email:
		Please send me updates on issues that concern me.

Phone (of Primary Attendee):

Business:

Home:

Cell:

Fax:

Requested by:

Name:

Phone:

Cell Phone:

E-Mail

Purpose of this request:

I’d like to meet Rep. Berkley to:
(Check all that apply)

Discuss a bill or legislation
Specify bill name or number:

Discuss an issue
Issue:

Introduce myself or others

Speak to a group

Request for assistance’

Subject & Details:

Location:

Please indicate preference for the meeting location:

Washington, DC Office (405 Cannon Office Building)
Outside of Nevada

Date and time:
you would like to meet:

Additional Attendees:

(Names, titles & affiliations)

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Schedule a meeting in D.C. Form

Requested by:

Purpose of this request:

Location:

Date and time:
you would like to meet:

Additional Attendees:

Washington, DC office [map it]

Las Vegas, NV office [map it]

Discuss a bill or legislation		Specify bill name or number:
Discuss an issue		Issue:
Introduce myself or others
Speak to a group
Request for assistance’

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Schedule a meeting in D.C. Form

Requested by:

Purpose of this request:

Location:

Date and time: you would like to meet:

Additional Attendees:

Washington, DC office [map it]

Las Vegas, NV office [map it]

Date and time:
you would like to meet: