Event Request — State Representative Jack Patrick Lewis

Invite Rep. Lewis to your event!

If you are also requesting a citation for your event, please fill out the citation request form.

If you have questions about requesting Rep. Lewis’ attendance or filling out this form, please contact Marianna at Marianna.Luciano@mahouse.gov.

Name

First Name

Last Name

Phone

(###)

###

####

Organization Requesting Attendance

Organization Address

Event Title

Is this event a fundraiser for your organization?

Event Date

YYYY

Event Start Time

Event End Time

Time Flexibility

Is the date or timing of the event flexible?

Event Format

Role of Representative Lewis

Honoring Others

Are there individuals or organization being honored at this event?

Citations

Would you like to request a citation from the House of Representatives? (A member of our staff will contact you if you would like to request a citation)

Speaking Time

How many minutes is Representative Lewis expected to speak? For events without a speaking role for Representative Lewis, please select 'N/A'.

Number of Attendees Expected

Media Availability

Is this event open to the press?

Social Media

Are there hashtags or organizations/individual tags that should be used for promotion of this event? If so, please feel free to include them below.

Additional Materials

Will you be providing additional promotional materials, such as graphics, flyers or videos?

Additional Questions/Comments

Please feel free to add any additional comments or questions below. If it is a long event, it would be particularly helpful to know exactly when you would like Representative Lewis to arrive.