Indicates required field Your InformationPrefix:- Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Mx.Rev.Dr.The HonorableRabbiFirst Name: MI: Last Name: Suffix:- None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and FamilyYour OrganizationOrganization:Your Contact InformationAddressAddressAddress 2CityState- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP CodeEmail:TelephonePhone NumberEvent Details Is this for a fundraiser? If so, what is the set ticket price and what is the money going to?What is the official name of the group and of the event/occasion?Is your organization based in NC? If not, where is the organization's primary headquarters located?- None -YesNoIs this event in-person or virtual?- None -VirtualIn-PersonWhat role will Congressman Davis' remarks play during the event? IF VIRTUAL: How will Congressman Davis' remarks be used — as a welcome, or part of a specific discussion? Do you plan to post video online, and will you be using it in any kind of social media?What is the date of your event?What time will Congressman Davis deliver his live or pre-recorded remarks? (if unknown, estimate the approximate time)How long would you like for Congressman Davis' to speak? (IF VIRTUAL, how long of a video would you like—not more than 3 minutes maximum) What would you like Congressman Davis' to speak about – is there a specific topic that is of interest to the audience?Who will be the audience for this event? And how many people do you expect? (a general overview – professions, industries, titles, etc) What is the overall program for the event/occasion? Who are the other speakers?What are the organization’s main accomplishments or points of pride?Does Congressman Davis need to recognize anyone? (Names and titles) NOTE: Please provide correct pronunciation/phonetic spelling of names so Congressman Davis says them correctly.Who is the point of contact (POC) for the event? What is their phone number and email address?Will media be invited to attend/observe Congressman Davis during this event?Will media be invited to attend/observe Congressman Davis during this event?- None -YesNoMaybe/TenativeOther…Please explain.What media do you expect to attend/observe? (please check all that apply)North CarolinaNationalTBD/UnsureInternational mediaNone/Not applicableHow many residents of North Carolina's First Congressional District do you expect to join/watch/attend Congressman Davis' remarks?Will you want Congressman Davis to participate in any audience or moderated Q&A? If so, please include as many details as possible regarding how you envision that portion of the program/Congressman Davis' remarks. If "NO", simply write "N/A".Please include any attachments or additional information that will facilitate Congressman Davis' participation in your event.One file only.2 MB limit.Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.