Please fill out the following form to make a request for Gregg Harper to attend your event or meeting. Someone from the campaign will contact you about your request as soon as possible.

You may also send your requests in writing to:

Gregg Harper for Congress
P. O. Box 54344
Pearl, MS. 39288

Phone: 601.420.2211 Fax: 601.420.2223

info@greggharperforcongress.com

Requests

Prefix First Name* Last Name*
Home Phone
Work Phone*
Fax
Email*  
County 
Name of Event 
Date of Event* Requested Date Day of Week
  Speaking Time Speech Length
Speech Topic
Person Intro 
Other Speakers 
Event Time Begin Time End Time
Inside or Outside  
Location Event 
Name Facility 
Facility Address
Directions to Facility
Sponsor Group/Org
Contact Person 1
Contact Person 2
Emerg Phone Number
Estimated Attendance
Press Attending?
Request Type
Attire
Bio Request
Notes