Meeting Request

If you are interested in meeting with me or my staff, please note that this request form is only for meetings in my DC office.



Name:
* Prefix * First Name * Last Name
* Address:
* City:
* State:
* Zip:
* Point of contact:
* Phone:
Business:
Mobile:
Home:
* Email:
Desired meeting location: DC
Will anyone from Ohio's 4th
Congressional District be
attending this meeting?
Yes No
If so who?
What is your connection with Ohio?:
Which issue/area of specialty
does this meeting concern:
Are you seeking meeting with
the Congressman, one of his staffers,
or either:
Preferred date/time:
Alternate date/time:
PURPOSE of meeting
including any specific
BILL NUMBERS: