Indicates required field Complete and submit this form to request Congressman Carson to speak at your event. Due to the Member's schedule, not all requests will be filled. ×Primary ContactNameFirst NameLast NameTitleOrganization NameStreet AddressCity/State/ZipCityStateZip CodeMethod of ContactEmailTelephoneEvent InformationEvent NameEvent Sponsor/OrganizerType of Organization- Select -Organization TypeBusinessCommunity GroupGovernment OrganizationNonprofitReligious OrganizationOther, Please SpecifyIf other, please specifyEvent Start Date & Time:(e.g. 2:00 PM)Start dateStart timeEvent End Date & Time:(e.g. 2:00 PM)End dateend timeFull Event AddressAdditional Information: For example: table number and location, name of building, location within a park).Event Venue/Event Type/Event Attireselect_venue- Select -Must Select VenueIndoorOutdoorOther, please specifyselect event type- Select -Must Select Event TypeBanquetConferenceNeighborhood MeetingRallyTourOther, please specifyselect event attire- Select -Must Select Event AttireBlack TieBusinessBusiness CasualCasualOther, please specifyOther Event Type/Other Event Attire:Other Event TypeOther Event AttireEvent DescriptionEvent size and audience composition (i.e. 20 high school graduates):Will media be present:media_present- Select -YesNomedia yes specifyList dignitaries and community leaders invited to eventDignitary/Community LeaderDignitary NameDignitary titledignitary confirmed- Select -Confirmed?YesNoDignitary/Community LeaderDignitary NameDignitary titledignitary confirmed- None -Confirmed?YesNoDignitary/Community LeaderDignitary NameDignitary titledignitary confirmed- None -Confirmed?YesNoDignitary/Community LeaderDignitary NameDignitary titledignitary confirmed- None -Confirmed?YesNoParticipation Information:What would the Congressman's role be at the event?If the Congressman is speaking, what time and for how long?:speech timespeech lengthWho will introduce the Congressman?Speaking AreaSpeaking Area- Select -StagePodiumOther, please specifyspeak area otherWhat topics would you request the Congressman covers in his remarks?Program InformationWould you like a congressional greeting for your program? If yes, what is the printing deadline for the program?greeting- Select -YesNogreeting timeWill there be any awards presented as part of the program? (If so, please list specific details)List the formal program/schedule for your eventIf the Congressman is unavailable to attend, would you accept any of the following: (check all that apply)unavail_optionVideoStaff RepresentativeCongressional GreetingIf you are requesting a staff representativeWill you acknowledge the representative?- None -YesNoMay staff deliver remarks or read a Congressional greeting?- None -YesNo