Video Request — U.S. Senator Tim Scott of South Carolina

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First Name*

Last Name*

Organization Name*

Email*

Enter Email Confirm Email

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Name Of Event*

Date Needed By*

Date Of Event*

Will Press be in Attendance? If so, please describe*

Preferred Video Length (note: due to time constraints, video messages will be under two minutes)*

Audience Information (Size, Notable Attendees)*

List anywhere video will be used outside of the event (e.g. social media)*

Suggested Remarks*

What is the primary thing you would like to make sure the senator says or addresses?*

Additional Information*