Meeting Request Form

Rep. Bernie Perryman District 14A

Please use the following form to request a meeting with Representative Perryman.

NOTE:
All fields marked with an asterisk (*) are required and must be completed.
Your message cannot exceed 3500 characters.

Event Name *

Organization Name *

Event Date *

Location *

Contact Person * Name of the event point of contact.

Phone Number * Phone Number of the event Point of contact.

Expected Role * Are you expecting remarks? If so, please provide details on length and topic.

Mailing Address

Purpose * If this is a meeting request, please indicate the bill number or topic you wish to discuss.

Participants * Use format: FIRST NAME, LAST NAME - TITLE, ORGANIZATION.

Relevant Background

Agenda *

Questions for Rep. Bernie Perryman