Congresswoman Suzan DelBene

Representing the 1st District of Washington

Event Request Form

Please note: While Congresswoman DelBene and her staff make every effort to meet with constituents of Washington state's 1st Congressional District and other groups, due to time constraints this is not always possible. This completed form needs to be received at least four weeks prior to the date requested before we can schedule any events. This form does not serve as a confirmation of the Congresswoman's participation. Someone from our office will contact you directly regarding the status of your request.

marks required fields of data.

Event Details

Location of Meeting:

Name of Person Requesting Event::

Organization:

Phone Number of Meeting Requester:

Cell::

Email:

Event Title:

Event Sponsor:

Type of Event:

Other Event Type:

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

Event Times: *

From:

To:

Time Requested of Rep. DelBene:

From:

To:

Event Location:

Parking Availabilty:

If yes, please provide address and/or describe location:

Desired Role of Rep. DelBene:

Purpose of Event:

Number of Attendees:

Will Media be Present:

If Yes, who:

Is the Congresswoman being asked to speak:

If yes, for how long:

What specifically will she be asked to speak about:

How does this issue relate to Washington State's 1st District:

Will there be a Q & A:

Will there be a microphone/podium:

Who else is speaking/organization

Will the Congresswoman be introduced:

If yes, by whom:

Contact for the Day of the Event:

Name:

Organization/Title:

Phone(mobile):

Email Address:

Recent Votes

Date	Roll Call	Bill	Vote
1/11/2017	45	H.R.5	Nay
1/11/2017	44	H.R.5	Aye
1/11/2017	43	H.R.5	Aye
1/11/2017	42	H.R.5	Aye
1/11/2017	41	H.R.5	Aye

Congresswoman Suzan DelBene

Representing the 1st District of Washington

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