Request an Appearance

Complete and submit this form to request Representative Harshbarger's appearance at a meeting, speaking function, or a non-speaking function. Due to the Member's schedule, not all requests can be filled.

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Activity Details

Type of Request:

Location of Event:

Date of Engagement:

Month

Day

Year

Number of Attendees:

Topic of Engagement:

Details:

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Your Information

Prefix:

First Name:

MI:

Last Name:

Suffix:

Your Organization

Organization:

Your Title:

Organization’s Website:

Your Contact Information

Address

Address 2

City

State

ZIP Code

Email:

Telephone

Phone Number

Phone Type:

What are these options?

Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone.