Rep. Haas Scheduling Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out the form in full. Representative Haas' office will be in contact with you.
All requests will be processed in the order they are accepted and availability.
Do Not fill out multiple forms for one scheduling request.

Email *

Type of request *

Meeting

Attend Event (reception, dinner, etc.)

Speak at Event (reception, dinner, etc.)

FOID/CCL Application

Other:

For whom are you requesting the meeting? *

e.g. Association, Individual, Company, Group, etc. Please include the full name of the individual, company or organization.

Date(s) *

Express one date as mm/dd, a date range as mm/dd-mm/dd and a variety of dates as mm/dd, mm/dd, etc. If you are flexible on the date, please write "Flexible."

Time *

If you are requesting a specific time, please choose "other" and write the time. If you can do both morning and afternoon, please choose "Flexible."

Flexible

Other:

Location *

If other, please provide the full address of the location

Kankakee District Office

232-N Stratton (Springfield Office)

Other:

Attendees *

Please include a list of all attendees in this format: Full Name (Title, Company), Full Name (Title, Company), Full Name (Title, Company), etc. If you are requesting the Representative's attendance at an event or reception, please include how many attendees you expect to be at the event and the general make-up of the group.

Agenda *

Please include the specific topics you would like to discuss or the agenda for the event depending on your type of request. Please briefly describe your issue if

Point of Contact *

Full name

Point of Contact *

Title and Company

Point of Contact *

Phone number

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 Illinois House Republican Staff. Report Abuse

Forms