Indicates required field CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance. 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. Please note that once this form is submitted, please allow up to 14 business days for our office to review and process your request. Providing complete and accurate information will help prevent any delays. ×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