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* Mandatory fields
Please allow a minimum of 4 weeks to process your request.
Event organizer
Name
*
Title
*
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Please enter your title
*
Job title
*
Email
*
Phone number
*
Date and time
Requested date
*
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*
Between
*
and
*
Check the days that apply
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Tuesdays
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Ideal times of day for the senator's visit or videoconference (time ranges are acceptable)
Location information
Please provide information about the location of your event
*
I am planning a visit to the Senate in Ottawa and would like my group to meet a senator there.
I would like the senator to speak to my group at our location.
Please select one of the options below
*
Virtually (by videoconference) only
In person, or virtually (by videoconference) if an in-person visit/event is not possible
In person only
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Please specify
Group information
The senator would be speaking to a
*
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What grade(s)?
*
School name/Organization name
*
Course name/Event name
City
*
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*
Event Information
Approximate number of participants
Would you like to request a particular senator?
*
No
Yes
Requested senator
Is there any additional information you would like to provide?
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How did you hear about this program?
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