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Meeting Request

Complete and submit this form to request a meeting with me or my staff. Due to scheduling demands, not all requests may be filled.

Your Contact Information

Prefix *

First Name *

Last Name *

Suffix (Jr., Sr.)

Street Address *

City *

State *

Zip Code *

Email Address *

Organization Name

Contact Phone Number *

Day of Event Mobile Phone Number *

About the Meeting

Available Dates and Times *

Preferred Meeting Date *

Location *

Will anyone from Ohio's 16th congressional district be attending this meeting? *
Yes
No

Are you seeking a meeting with the congressman, one of his staffers, or either? *

Names and Hometowns of Attendees *

What is the purpose of the meeting? *

Specifically, what topics do you wish to discuss? *

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