Event Request Form — U.S. Senator Tim Scott of South Carolina

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Organization(s) Making Request*

Prefix

First Name*

Last Name*

Email*

Enter Email Confirm Email

Phone Number*

Alternate Phone Number

Onsite Point of Contact*

Onsite Point of Contact Cell Phone*

Name Of Event*

Type of Event

Date Of Event*

Media Expected*

Event Start Time*

Event End Time*

Time Senator Requested To Speak (If Requested):

Length Of Speech:

Event Location:

Event Address

Street Address Address Line 2 City State ZIP Code

Is Parking Available? If so, where?

Senator's Role at Event

Podium/Stage Format

Event & Background Information (Please provide a copy of any news release or agenda)

Order Of Speakers (Please indicate invited or confirmed)

Topic Of Speech

Expected Number Attending

South Carolinians Invited or Confirmed (Please Indicate)

Dignitaries or Speakers Invited or Confirmed (Please Indicate)

Will consider staff if Senator is unavailable?

Send greeting letter or video if Senator is unavailable?

Other Comments: