Office of Senator Maria Cantwell Scheduling Request Form

Note: Please note that due to the large number of requests for the Senators time we are not able to accommodate every request. In the event that the Senator is unable to meet our staff will be in contact with you.
Todays date: (Insert text here) Date(s) requested: (Insert text here) Times preferred: (Insert text here) Type of event: Meeting Speaking request

Other: (Insert text here) Contact Person: (Insert text here) Sponsoring Organization: (Insert text here) Name: (Insert text here) Address: (Insert text here) Phone numbers: (Insert text here) Email: (Insert text here) Have you requested a meeting with our office before? APPOINTMENT ONLY List of Attendees: (Insert text here) Total Number: (Insert text here) Topics for discussion: (Insert text here) Yes No If yes, please provide details:

If Senator Cantwell is unavailable, are you interested in meeting with her legislative or outreach staff? Yes No If yes, someone from our office will contact you to set up a date and time to schedule an appointment. SPEAKING REQUESTS ONLY Event Title: (Insert text here) Subject of Event: (Insert text here) Event Location: (Insert text here) Event Duration: (Insert text here) Number of attendees: (Insert text here) What do you see as the Senators role in your program? (Insert text here)

Requested topic(s) for remarks: (Insert text here)

Do you want time for questions? If so, please indicate how much time you would like. (Insert text here) Speaking format: (Insert text here) Will there be a podium? (Insert text here) Will be there be a microphone? (Insert text here) Will anyone be introducing the Senator? If so, who? (Insert text here) Who else has been invited to speak? (Insert text here) Event agenda: (Insert text here) Who will be in attendance? (Insert text here)

Please be sure to include any special guests you have invited, as well as an approximate headcount.) (Insert text here) Will media be invited? (Insert text here) Additional Information: (Insert text here)

Please return to: Claire Gallagher State Scheduler Phone: (206) 220-6400 Fax: (206) 220-6404 Email: State_Scheduling@Cantwell.Senate.Gov