Event Request Form

Please fill out the below form to request Doug's attendance at your event!

Thank you for supporting Doug's campaign!

Event POC First Name *

Event POC Last Name *

Email *

Phone *

Event Name *

Event Venue *

Event Address *

County *

Event Type (Fundraiser, Keynote Speaker, Multiple Speakers, Meet and Greet, Other - If Other Please Describe Event) *

Number of Expected Attendees *

Is The Date Flexible *

{If Not Flexible} Event Date

{If Not Flexible} Event Time

How much time is allocated to Doug speaking? *

Will there be other speakers at this event? (Yes or No) *

{If Yes} Who else will be speaking?

Who will be attending? *

Why is this event important for Doug to attend? *

If Doug cannot attend, would you like a team member with material to distribute at this event? (Yes or No) *