DC Scheduling Requests

DC Scheduling Requests

Note: Fields marked with an * are required.

It is an honor and privilege to represent the constituents of Nebraska and I embrace the opportunity to meet with residents throughout our great state. Although the Senate schedule inhibits me from attending every event, a member of my staff would be pleased to attend in my absence.

If you have an event or meeting that you would like me to attend in Washington, D.C., please fill out the following form and a member of my staff will get back to you as soon as possible. If you have any questions, please call 202-224-6551.

Request Type *

Meeting Event/Speaking

Speaking Requests Additional Info

Will the Senator be speaking at this event?

Yes No

How long is she being asked to speak?

What is the topic for the speech?

Will there be a Q&A; session with the Senator?

Yes No

Is this event open to the Press?

Yes No

Request Information

Please indicate if this is a request for the Senator or a staff member *

Senator Staff

Name of Group/Organization *

Description of Group/Organization *

150 characters limit

Purpose for Meeting/Event *

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

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 mm/dd/yyyy. Events lasting several days must be separated by commas (ex. 01/10/2016, 01/11/2016.)

Time of Event or Availability for a Meeting *

Location *

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

Participant 1

Name

Email

Hometown

Participant 2

Name

Email

Hometown

Participant 3

Name

Email

Hometown

Participant 4

Name

Email

Hometown

Participant 5

Name

Email

Hometown

Additional Participants

Please enter names, email addresses, and hometowns for any additional participants in the space provided.

Contact Information

Prefix

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

AA AE AP 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

Any Additional Information