You must have JavaScript enabled to use this form. First Last Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Organization Email Address Mobile Phone Number Are you looking for a: - None -Virtual Legislative MeetingVirtual Constituent MeetingVirtual Speaking EngagementMedia InquiryConferences Legislative Concern/Topic: Do you want to discuss a bill? Yes No Please state the Bill # (AB or SB) and your position on each bill. If possible, please provide the status of the bill, and a deadline. Due to the high volume of scheduling request – If the Assemblyman is unavailable to meet, are you willing to meet with staff? Yes No Will there be constituents in this meeting? Yes No Please provide names, and city or zip code they reside in. Are you able to provide a conference number or conference link? Yes No Please provide a conference number or conference link Please describe your request in detail. Have you communicated with the 27th Assembly District Office on the issue prior to this request? Yes No Please provide the name of staff, date, and time, in which you contacted my staff. If this is a meeting request, please provide first name, last name, titles and zip code of all attendees. Are you able to provide a conference number or conference link? Yes No Please provide a conference number or a conference link Is this a LIVE conversation? Yes No Topic of Discussion How much time do you need Assemblyman Kalra to speak? Who is the audience of this event? Will you be providing background information and talking points at least 5 business days prior to your event? Yes No What is the platform? Are you able to provide a conference number or link? Yes No Please provide a conference number or a conference link Before any use of the Assemblyman’s name, photo, or likeliness for an event, please obtain authorization from my Office by email before use. Yes Are you requesting a pre-recorded video? Yes No Length of the video? If you have a preference on a media-streaming platform, please provide name Please provide background for the talking points One file only.200 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Before any use of the Assemblyman’s name, photo, or likeliness for an event, please obtain authorization from my Office by email before use. Yes News or media outlet Deadline Email Address Cell Phone What is this regarding? Please provide your questions in advance. Are you looking for a quote? Yes No Is this a Live interview? Yes No Please provide date, time, call in number or call in link. Is this a Pre-recorded interview? Yes No How much time do you need for this interview? What is the Assemblyman's role? Dates and Time Location Who handles your FPPC? (Please provide name, phone, and email address.) Before any use of the Assemblyman’s name, photo, or likeliness for an event, please obtain authorization from my Office by email before use. Yes CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.