Official Meeting Request Form

Please complete all of the required fields below, and someone from our District Team will be in touch.

Full Name:* First Name:*

Last Name:*

Email Address: *Email: *

Address: *

City: *

State: *

Zip Code: *

Phone Number: *Phone: *

Whom are you requesting a meeting with? *

District Team Rep. Brown

Individual / Organization Name *

Individual / Organization Description *

Topic of Discussion / Meeting Agenda *

Specific Concerns / Legislative Priorities *

Number of Attendees *

List of Attendees *

Are you open to a virtual meeting? *

Yes, that's fine. No, I prefer in-person.

Preferred Date *

Preferred Time *

Alternate Availability *

Name, Phone, Email of Contact for Day of Meeting *