Event/Speaking Invitation – Washington

Please complete and submit the form below to request that Congressman Phillips appear at a speaking or non-speaking function in Washington, DC. Due to the Congressman's schedule, he may not be able to accommodate all requests.

Required fields are followed by *.

Event Details

Organization Name: *

Requester's First Name: *

Requester's Last Name: *

Organization Address: *

Organization Address: (Continued)

City: *

State: *

Zip Code: *

Email Address: *

Phone Number: *

Day of Event Point of Contact: *

Day of Event Phone Number: *

Anticipated Number of Attendees: *

Name of the Event: *

Location of the Event: *

Event Date: *

Event Start Time: *

Event End Time: *

What is the Congressman’s role (request for remarks, award recipient, honored guest, attendee, etc.)?: *

If you are requesting remarks, please tell us more (proposed topic, prepared questions, general Q&A, etc.): *

Details and Event Background (please include a timeline of events or tick-tock and your ask here): *

Please attach the event invitation via PDF or MS Word only.

Files must be less than 500KB and greater than 0KB.
Allowed file types: pdf doc docx