Request edit access
2024 Lawmaker Visits & Community Events
Please let us know when you schedule visits with lawmakers and hold community events. This will help us understand which lawmakers have had a chance to see health center clinics and identify potential advocacy opportunities. Please also use this form to let us know if you would like staff or lobbyists from the Association and Network to join the visit. If you have any questions, please contact Patrick at pjones@wacommunityhealth.org
Sign in to Google to save your progress. Learn more
Community Health Center? *
Main Contact
Main Contact Email *
Type of tour, visit, or meeting *
Name(s) of Lawmaker or Executive Office Member (Answer N/A if no Leg is involved) *
Is this event or visit part of National Health Center Week? *
Date *
MM
/
DD
/
YYYY
Clinic or Meeting Location
*
Congressional District 
Legislative District 
Community Event: Name and/or Brief Description
Would you like staff from the Association or Network to join this visit or event? We will follow up if so.  *
Anything else we should know?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report