Organization Name *

Event Date *

Event Time *

General Overview of Organization Making Request

Is Senator Albers' bio required for pre-advertising purposes?
YesNo

Will Media be in Attendance?
YesNo

Would you like Senator Albers to speak?
YesNo

Is a speech required?
YesNo

Of what length?

What Topic?

Are questions allowed after the speech?
YesNo

Is there a monetary requirement for attendance?
YesNo

Who or what organization benefits from the monetary requirement?

Your Name *

Your Address

Phone Number

Email Address