Please complete and submit this form to request a meeting with Congressman Emmer. This form should also be completed by parties interested in having the Congressman attend an engagement, speak at an event, or tour a business. Indicates required field Please note that electronic communication, particularly e-mail, is not necessarily secure against interception. Please do not send sensitive data (e.g., Social Security, bank account, or credit card numbers) by e-mail or web forms. Activity Details Type of Request: - Select -Meeting RequestSpeaking Request Location of Event: - Select -In DistrictIn Washington, DC or elsewhere Date of Engagement: Month MMJanFebMarAprMayJuneJulyAugSepOctNovDec Day DD01020304050607080910111213141516171819202122232425262728293031 Year Topics and legislation the group would like to discuss: Number of Attendees: Names, titles, and hometowns of attendees: If attendee list is not finalized, enter # of attendees expected Details: Your Information Prefix: - Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Mx.Rev.Dr.The HonorableRabbi First Name: MI: Last Name: Suffix: - None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and Family Your Organization Organization: Your Title: Organization’s Website: Your Contact Information Address Street Address Address 2 City State - 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 VirginiaWisconsinWyoming ZIP Code Email: Telephone Phone Number Phone Type: - None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD] phone text What are these options? Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.