Schedule a Meeting Form

Rep. Long and his staff look forward to the opportunity to meet with you.  Please complete this form so you will have an electronic copy of your meeting request.  Once the office receives your meeting request form the scheduler will follow-up in a phone a call. 

* indicates required field.

Contact Information

Organization:*

Salutation:* Please select one Mr. Mrs. Ms. Dr. Rev. Prof. Maj. Col. Fr.

First Name:*

Last Name:*

Street Address:*

Address 2:

City:*

State:* AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:* +4 (Determine your ZIP+4)

E-mail Address:*

Telephone Number:*

Meeting Request Details

Subject of Meeting:* Please select one: Agriculture Budget Defense Economy Education and Labor Energy Environmental Government Reform Health Homeland Security Immigration International Relations Judicial Social Issues Social Security Taxes and Trade Telecommunications Transportation Veterans Welfare Other

Meeting location:*

Attendees:*

Preferred Date/Time:*

Purpose of Event/Meeting *

Other/Additional Information: