By filling out this form, you consent your organization's name to be published on a letter of support from IIUSA sent to Members of Congress. You also certify that you are authorized by your organization to sign on to this letter on behalf of your organization.
First Name *
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Last Name *
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Title
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Direct Contact Phone Number
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Email *
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Full Name of Organization *
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Business Address
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City
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State *
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ASM
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Zip Code
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Are you an IIUSA member?
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Are you authorized by your organization to sign on to letter? *
Are you a national or state organization?
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Which state(s) do you do business in? (Please put "N/A" if you are a national organization)
Please use state abbreviations and use space to seperate multiple states (i.e. AL AK AR)
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With what sector does your organization associate itself?
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