Ask Dan to Speak

Senator Dan Patrick Speaking Request Form

Thank you for your inquiry into Senator Patrick’s availability to speak at your event. Please complete and submit the request form below. Please note that an attachment (notice, flyer, etc.) may be submitted with your request at the bottom of the form.

All items noted in RED below are required for submission. If you do not receive an acknowledgement call or email within 72 hours, please feel free to call Donna at 832-390-0107.

 

Speaking Request Information
Event Name:
 
Event Date:
 
Event Beginning Time:
 
Event Ending Time:
 
Speaking Location:
 
  Location Address
 
  Location City
 
  Location Zip Code
 
Approx start time for Dan's speech:
 
Approx. length of speech:
 
Expected size of group:
 
Recommended dress:
 
Other notable or
legislative attendees: 		 
Organization’s Executive(s):  
Theme or suggested topic:
 
Brief description of event & organization:
 

Contact Information
Contact Name
 
E-mail:
 
Phone number:
 
Additional phone number:  
Best cell phone to call on
event day/time:
 
Address:
City:
State:
Zip:
Additional Contact Name
for the time of the event 		 
Additional Contact Mobile
for the time of the event 		 
 
Comments:
Attachment:
If you wish, please attach a flyer or other document giving more information about your organization or event request.
        

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