JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
RESULTS Lobby Report Form 2012
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Which member of Congress?
*
Your answer
Your contact information (optional)
Your answer
What is your state?
Your answer
Which RESULTS Group are you from?
*
Your answer
Which issues does your group primarily cover?
Your answer
What was the date of your meeting?
*
Format: mm/dd/yy
Your answer
What kind of follow up is required?
Your answer
The meeting was:
face-to-face with a Senator
face-to-face with a Representative
with staff
Clear selection
Who did you meet with?
Your answer
How would you rate this member of Congress on the Champion Scale?
Your answer
Which activists, experts, or community members attended the meeting with you?
Your answer
Name(s) of aide(s) who attended meeting
Your answer
Which issues did you cover during the meeting?
Your answer
Describe how the meeting went and what was accomplished.
Your answer
Who is making this Report?
Your answer
Who is Your Regional Coordinator?
*
David Burns
Anne Child
Meredith Dodson
Kathleen Duncan
Peter Fiekowsky
Allison Gallaher
Frank Gilbert
John Hornby
Jos Linn
Cathy Lyons-Spear/Heide Craig
Lisa Marchal
Ken Patterson
Bruce Preville
Ginnie Vogts
Kem Spaulding
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
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
