Host An Event

Host An Event

Event Name/Description (please note if a fundraising event, and for what/whom): *

Organization: *

Date: *

Start Time: *

End Time: *

Location of Event

Address: *

City: *

State: *

Zip: *

Anticipated Attendance: *

Public

Invited Guests

Estimated number of Attendees: *

Event Format: *

Attire:

Role Requested:

If Speaking role:

Duration of Speech:

Requested Topics (“any” if no specific topic is requested):

Other scheduled Speakers:

Will a Podium and/or Microphone be available? :

Will press cover the event?

May we invite:

Press

Supporters

Event Contact/Title: *

Phone Number: *

Cell Number:

Fax Number:

Email: *

Additional Notes:

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Quinn for Illinois