Invite Me To Speak

Invite Me To Speak

Note: Fields marked with an * are required.

Complete and submit this form to request Congressman Fitzpatrick’s appearance at a meeting, speaking function, or a non-speaking function. Due to the Member’s schedule, not all requests will be filled.

Speaking Invitation Request Details

Subject of Engagement: *

Location of Engagement: *

Washington D.C Pennsylvania

Exact Date of Engagement: *

Details: *

Your Information

Organization:

Prefix:

Ms. Miss Mrs. Mr. Mr. and Mrs. Rev. Dr. The Honorable Rabbi

First Name: *

MI:

Last Name: *

Suffix:

Position Title: *

Street Address: *

Street Address Continued:

City: *

State: *

Zip: *

Telephone Number: *

Phone Type: *

Voice VP TTD

Email: *

Human Validation

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