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Event Invitation
Have an event that you would like Rep. Buckner to attend? Please fill out this form. Thank you for being civically involved and caring about our communities. If you have any other questions or concerns please feel free to email us at
buckner@illinois26.com
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* Indicates required question
Name of Event
*
Your answer
Address for Event
*
Your answer
Is there parking?
*
Yes
No
Date for Event
*
MM
/
DD
/
YYYY
Time of Event
*
Time
:
AM
PM
Is the Representative needed to speak?
*
Yes
No
Maybe
Theme and what the Representative will need to discuss?
*
Your answer
Audience (example; youth, law enforcement, etc.)
*
Your answer
Are there any other elected officials invited or have confirmed to attend the event?
Yes
No
Clear selection
Name of Event Organizer, Planner, or Point of Contact for the day of
*
Your answer
Contact Number of Event Organizer, Planner, or Point of Contact for the day of
*
Your answer
Email of Event Organizer, Planner, or Point of Contact for the day of
*
Your answer
Organization You Represent
*
Your answer
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