Event Scheduling Requests | U.S. Congressman Henry Cuellar, Ph.D.

Your Contact Information

Full Name: *

Organization:

Address: *

Address2:

City: *

State: *

Zip: * -

Email: *

Phone: *

Fax:

Cell Phone:

Request for Congressman to Speak? Yes No

If 'Yes', has Congressman spoken to this group before? Yes No

If 'Yes', when and about what?

If surrogate attends, speaking role? Yes No

Time to Speak:

Introduced by:

List Issues to be Addressed:

Other Issues of Interest to Group:

General Event Information

Event Date: *

Day of Week: *

Event Time: * From: To:

Time Congressman to Arrive:

Event Name: *

Event Description:

Event Location Name:

Event Address: *

Event Address 2:

Event City: *

State: *

Zip: * -

Event Location Phone:

Media Attending: Yes No

Media Outlet: TV Print Radio

Audience Size:

Audience. Description: (profession, age, orgs)

VIPs to Attend: Yes No If 'Yes', Who?:

Contact Information for Day of Event:

Name:

Phone: (Cell preferred)

Additional Information Requested:

Photo/Biography of Congressman Requested: Yes No

If 'Yes', Send to:

Date Required:

Additional Comments: