Schedule a Meeting - Thank You

TODAY’S DATE: [required-date]

YOUR CONTACT INFORMATION

YOUR NAME:    [required-honorific-prefix] [required-first] [required-last]        
EMAIL ADDRESS:    [required-valid-email]
PHONE #: [required-phone]    
CELL #:    [required-cell]    

MEETING INFORMATION

I AM REQUESTING A MEETING WITH (PLEASE CHECK ONE):
[pearce]

I AM REQUESTING ATTENDANCE AT AN EVENT:
[event]

SECTION A

I PREFER TO MEET AT THE FOLLOWING LOCATION
[meeting]

MY GROUP OR AFFILIATION I AM REPRESENTING IS:
[required-group]

MY GENERAL PURPOSE/TOPIC TO BE DISCUSSED:
[required-topic]

PREFERRED DATE(S): [required-preferred]

PREFERRED TIME: [required-time]

PLEASE LIST THE NAMES (INCLUDING ANY TITLES AND/OR AFFILIATINS) OF ALL INDIVIDUALS EXPECTED TO ATTEND THE MEETING/EVENT AND/OR ESTIMATED NUMBER OF ATTENDEES:
[required-attendees]

ARE YOU THE POINT OF THE CONTACT FOR THE DAY OF THE MEETING?
YES, my cell and contact # is:
[poc-cell]

Will you be attending/travelling with the group? [traveling]

NO, the name of the person is:  Their Cell and Email is:
[alternate]

SECTION B

LOCATION W/COMPLETE ADDRESS (INCLUDING ZIP CODE):
[required-address]

DIRECTIONS TO LOCATION (IF APPLICABLE):
[directions]

IS THIS A PUBLIC OR A PRIVATE EVENT: [event_type]

DURATION OF EVENT: [required-duration]

WILL THERE BE MEDIA AT THE EVENT: [media]

ATTIRE FOR THE EVENT (I.E. CASUAL, BUSINESS OR FORMAL):
[required-attire]

HOW LONG WOULD THE CONGRESSMAN BE SPEAKING: [speak-time]

ON WHAT TOPIC: [speak-topic]

WILL THERE BE Q&A AFTER HIS SPEECH: [qa]

WILL THE CONGRESSMAN BE SPEAKING FROM A STAGE OR PODIUM: [podium]

WILL THE MICROPHONE BE MOUNTED OR HANDHELD: [mic]

WHAT IS THE SETTING FOR THE EVENT (I.E. – RELAXED OR FORMAL EVENT):
[setting]