Stefani Zinerman - Assembly District 56 |Assembly Member Directory

Event Appearance Request Form

Please fill out the form below to invite Assemblymember Zinerman to attend your event. Someone from our office will respond to your request within 48 hours.

Contact information

Organization(s) Making Request

First Name

Last Name

Verify Email

Phone Number

Title/Role/Affiliation Within Organization

Event Details

Name Of Event

Event format

Reception

Dinner

Keynote

News Conference

Other

Will the event be in-person or virtual, open to press, live streamed, and/or recorded?

Date of Event

Event Start Time

Event End Time

Time Assemblymember Requested to Speak (If applies)

Topic of Speech

Length of Speech (If applies)

Event Location - Name of Venue

Address:

Apt Number

City

State

Zip

Event & Background Information (Please provide a copy of any news release, Flyer, agenda, images, etc)

Order of Speakers (Please indicate who is invited & who is confirmed, if available)

Expected Number Attending Event

Please list other elected officials – and indicate which are invited, as well as who has been confirmed)

Any additional information that would be helpful

User Name