North Dakota Event Request

"*" indicates required fields

Organization Making Request*

Point Of Contact

First Name*

Last Name*

Email*

Phone Number*

Alternate Phone Number

Onsite Point of Contact*

Onsite Point of Contact cell phone*

Name of Event*

Media Expected*

Date of Event*

Time of Event*

Time Senator Requested to Speak

Length of Speech

Event Location

Address

Is parking available? If so, where?

Senator’s Role at Event

Podium/Stage format

Event & Background Information (Please provide a copy of any news release or agenda)

Order Of Speakers

Topic Of Speech

Expected Number Attending

North Dakotans Invited or Confirmed (Please Indicate)

Dignitaries or Speakers Invited or Confirmed (Please Indicate)

Will consider field representative if Senator is unavailable?

Send Greeting Letter or Video if Senator is unavailable?

Other Comments