Legislative Contact Response Form

In order for us to gauge the outcome of our legislative grassroots contacts, please complete the brief form below about your conversation with your Senator or Representative regarding our issues.

Your Name
First Last
Other Members in Attendance
Please list all members who were in attendance with you.
Name of Legislator
Date of Meeting
MM slash DD slash YYYY
Whom did you speak with? Check all that apply.
- The Senator
- The Representative
- The Staff (please provide name)
- Other (please provide name)
Name of staff or others if applicable
What issues were discussed during you visit?
Do they want a call/visit from our Lobbyist, Tim Meenan?
- Yes
- No
Describe your Conversation
Please use the space below to describe your conversation. Please make sure to include your legislator’s position on the issue.
Phone
This field is for validation purposes and should be left unchanged.

Legislative Contact Response Form

Legislative Contact Response Form

Author: naifaflo

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