1 - Telephone *

2 - Individual/Business/Agency or Organization Name *

3 - Individual/Business/Agency or Organization mailing address

4 - Type of Request *

5 - What is the purpose of the meeting/event? *

6 - In the event Leader McClinton is unavailable, I am agreeable to meet with senior staff on her behalf. *

7 - Meeting/event Date (If a pre-determined date has not been identified, please provide suggested dates and times) *

8 - Meeting Start and Ending Time

9 - In-person meeting location (provide exact address, including building name, room, suite or floor number)

10 - Who is the target audience?

11 - Is the event/meeting open to the public? *

12 - Will the event be held live on Social Media? If yes, please provide the platform details.

13 - If Rep. McClinton is being requested to speak, what is the allotted time-frame and specific topic of discussion? If the meeting will include a Q&A segment please include the questions below. Note: Any changes to the discussion topic must be received 10 days prior to the meeting/event date)

14 - Are you requesting to have Rep. McClinton remain in the meeting after speaking?

15 - Please provide the names of senior level staff that will be in attendance.

16 - Please provide the meeting agenda (if the agenda is not finalized, please provide a draft)

17 - Please provide the name, telephone number and email address for the contact person on the day of the meeting. *

18 - Please provide additional details that may be helpful.

19 - Video Recordings: Please provide the purpose, discussion topic, video length, technical/recording requirements and the name and email address to where the video should be sent.