Event Request Form

Name of Person Requesting Event:

Organization:

Phone Number of Meeting Requester:

Cell:

Email:

Event Title:

Event Sponsor:

Type of Event: (Please Check One)
Forum Reception Dinner Briefing Luncheon
Other Event Type:

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

Event Times:

From:

To:

Time Requested of Rep. Kilmer:

From:

To:

Event Location:

Parking Availabilty: Yes No

Desired Role of Rep. Kilmer:

Purpose of Event:

Number of Attendees Expected:

Will Media be Present: Yes No

If Yes, who:

Is the Congressman being asked to speak: Yes No

If yes, for how long:

What specifically will he be asked to speak about:

How does this issue relate to Washington State's 6th District

Will there be a Q & A: Yes No

Will there be a microphone/podium Yes No

Who else is speaking/organization:

Will the Congressman be introduced Yes No If yes, by whom: