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Congresswoman Alma Adams
Representing the 12th District of North Carolina
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Event Request
Complete and submit this form to request my appearance at a speaking or non-speaking function. Due to the my schedule, not all requests will be filled.
Your Contact Information
Prefix
First Name *
First Name is required
Last Name *
Last Name is required
Suffix
Email Address *
Email is required
Invalid Email
Organization Name *
Organization Name is required
Contact Phone Number *
Contact Phone Number is required
Phone number must be 10 digits
About the Event
Event Name *
Event Name is required
Address *
Street is required
City *
City is required
State *
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IN
IL
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 *
Zip is required
Zip has to be a number
Event Date *
Event Date is required
Event Time
Event Time is required
Dress Code
Number of Attendees
Event Background
Requested Role
Type of Appearance
Keynote
Welcome
Brief Remarks
Drop By Only
Introduced By
Other Speakers
Speaking Arrangements
Head Table
Lectern
Stage
Mic
Podium
Who is the MC?
Bio Needed?
Yes
No
Photo Needed?
Yes
No
Open to Public?
Yes
No
Press in Attendence?
Yes
No
Additional Information
