Field Campaign Event Form

Event Date:
Start Time:     Stop Time:
Event Name/Type:
Address:
City:
State:
Zip:
Request made by:
Email:
Phone:
Campaign person in charge:
Event Details:
	Number of attendess?
	Number of volunteers?
	How much literature required?
Yes    No	Are signs and banners permitted and needed?
Yes    No	Is someone from the speaker’s bureau needed?
Yes    No	Is a local contact needed to make introductions?
Yes    No	Are there any fees required and if so are the expeditured approved?
Yes    No	Followup needed?
Yes    No	Notify all local supporters & volunteers?
If Yes, How?
Earned media potential?
Special Notes/Comments: