Congresswoman Carolyn Cheeks Kilpatrick - Appointment Scheduling Request Form

If you would like to schedule an appointment with the Congresswoman, please complete the scheduling form below. All appointments with the Congresswoman are confirmed in writing ONLY, usually one to two weeks in advance. No appointments are confirmed by telephone or in person. If you have not received written notice seven days before a requested appointment, please send an e-mail toAndrea Bragg (Detroit events) or Marvene Resendez (Washington, DC events).

PLEASE NOTE: Fields marked with an asterick (*) are required fields and must be filled out.

Contact Information:
* Name:
Organization: (if applicable)
Job Title: (if applicable)
* Address 1:
Address 2:
* City:
* State:	* Zip Code:
* Daytime Phone:	(must include area code)
* After Hours Phone:	(must include area code)
* Email:

Appointment Information - Please fill out the following fields to request an appointment with Congresswoman Kilpatrick:
* Choose Location:
* Attendees:
* Days of the week & times you are available:
* Topic(s) you would like to discuss:
Additional Comments: