Request a Meeting in Florida

Complete and submit this form to request Congressman Bilirakis’ appearance at a meeting, speaking function, or a non-speaking function in Florida's 12th District. Due to the Member’s schedule, not all requests will be filled.

* marks required fields of data.

Activity Details

Type of Request: *

Date of Engagment *

Estimated Time frame: *

Number of Attendees: *

Topic of Engagement: *

Details: *

Your Information

Prefix: *

First Name: *

MI:

Last Name: *

Suffix:

Your Organization

Organization: *

Your Title: *

Organization’s Website: *

Your Contact Information

Street Address: *

Street Address Continued:

City: *

State: *

Zip Code: *

Email: *

Telephone

Phone Number *

Phone Type:

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.

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Request a Meeting in Florida

Office Locations

Washington Office

New Port Richey Office

Tarpon Springs Office