Request Elected Official's Presence

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Please use this form to request the presence of your Elected Official at an event.
* Indicates a required field.

Which Elected Official would you like to attend the event? *
Do you want the Official to speak at the event? * Yes No
Attire: *


Contact Information

Requested by:	*
Title:	*
Organization Name:	*
Contact Person:	*
Contact Phone Number:	*		i.e. 408-444-5555
Contact Fax Number:	*		i.e. 408-444-6666
Contact Email:	*

Event Information

Date of Event:	*		i.e. 12/04/2002
Type of Event:	*
Event Start Time:	*		i.e. 9:30 am
Event End Time:	*		i.e. 10:30 am
Location Address:	*		i.e. 58 Main St., Room 132
City:	*		i.e. San Jose
Phone Number at Event:	*		i.e. 408-333-5555
Description of Audience:	*
Estimated Turnout:	*
Media Invited:	*
Please contact me via:	*	Phone Email Fax

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