JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Event request for NDP Chair Jane Kleeb
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your name, email and phone number (indicate if cell)
*
Your answer
Your group/organization
*
Your answer
What date and time (please use Central Time) are you hoping to speak to Jane or have her attend your event?
*
MM
/
DD
/
YYYY
Is there an alternate date and time?
*
Your answer
What is the topic/what would you like Jane to address?
*
Your answer
Would this be in person, via phone or via Zoom?
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Nebraska Democratic Party.
Report Abuse
Forms
