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CODEPINK Congressional Liaison report-back form
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* Indicates required question
What is your name?
*
Your answer
What is your email?
*
Your answer
Who is your Congressperson?
*
Your answer
What have you done so far? (check all that apply)
*
Have not reached out yet
Reached out to staffer
Scheduled meeting
Had the meeting
Required
Can you provide the name/email of the staff member you've made contact with?
Your answer
Who is participating in the meeting? (Names and organizational affiliation)
Your answer
List legislation you are meeting to discuss.
*
Your answer
Meeting Outcome
How much did they support the legislation?
Not at all supportive
1
2
3
4
5
Supportive - will cosponsor
Clear selection
Do you have notes about what they supported, or any reservations they have about the legislation?
Your answer
Is there any follow-up required? Do you need support from us?
Your answer
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