2025-2026 PHCC Chapter - Request for Leadership Attendance

PHCC Chapters - please use this form when requesting a member of the PHCC Executive Committee or National staff to attend an in person meeting or event.

Leadership and national staff can swear in your board, give a national update, or speak on any requested topic.

Please reach out to Jordan Fleger fleger@naphcc.org with any questions.

Thank you.
Chapter Name:*
Your Name*
Email*
example@example.com
Title of Whom you are requesting:*
Name of whom you are requesting to attend your event (if known):

First NameLast Name
State/Local that will be visiting?*
What event is this (annual conference, legislative conference etc.? *
.
What is the name of the hotel, city and state?*
Date they would arrive*

MonthDayYear
Date
Date they would leave *

MonthDayYear
Date
Proposed meeting agenda

Browse Files

Cancelof
Invitation

Browse Files

Cancelof
Reasons why you are requesting the above to attend: (examples: membership booth, election of new board members, PHCC National update)*
Additional comments
Yes, I understand I will be providing free registration to this person*

AgreeDisagree
Yes, I understand I will be responsible for paying for their hotel room and PHCC National will pay for travel and incidentials.*

AgreeDisagree
Thank you for your travel request. We will let you know once it has been approved.
Should be Empty: