Event Request Form

If you would like to invite me or a member of my staff to an event, please fill out the scheduling request form below. Please keep in mind that all of my appointments and attendance at events must take place around votes in the House and other official legislative business.

If you would like to request a meeting with meplease use this form.

Fields with an asterisk(*) are required.

Name:*

Organization:
(if applicable)

Job Title:
(if applicable) 

Address 1:*

Address 2: 

City:*  

State:*   KY

Zip Code:*   [required-zip5]

Daytime Phone:*  

After Hours Phone:*    

Email:*  

Event Information - Please fill out the following information to invite Ben to an event.

Event Type:*

Event Location*

Is the Event Open to the Public?*

Is the Event Open to the Media?*

Date of Event:
(mm/dd/yy)*

Start Time:*

End Time:*

Location/Place
Event Will
Be Held:*

Directions from nearest federal or state highway:*

Estimated Number Attending:

Event Theme:

Additional Comments

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