DELEGATION SPEAKING REQUEST FORM

SPEAKING REQUEST FORM

Please *fully* complete this form by Monday, September 20th, 2021.
Name of Organization*
Contact Person*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Person Speaking*

First NameLast Name
Is this a legislative proposal?*

YesNo
What is your topic concerning?*
Brief explanation of the proposal*
Is this a funding request?*

YesNo
If yes, how much is the request?
Have you received funding for this project in the past?

YesNo
If yes, how much?
Have you met with a State Legislator regarding this issue?*

YesNo
If yes, who?
Please attach any materials you would like to present to the delegation. Example: supporting documentation, previously filed requests for this proposal, etc.

Browse Files

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Thank you for filling out the speaking request form. Please contact the Office of Senator Debbie Mayfield should you have any questions:

(321)-409-2025
smith.karly@flsenate.gov
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