May 23, 2022 District 12 Virtual Town Hall Registration Form
Please submit your questions to the District 12 members here. District 12 staff will monitor the submissions and pass them on to your members.

The Town Hall will start at 7:00 pm on Monday, May 23rd, 2022. Please watch the livestream on our YouTube Channel: https://www.youtube.com/channel/UCmxHdpQ-ZJexll4A-x7bvUw/
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
House Number *
Street Name *
Apartment Number (if applicable)
City *
Zip Code *
Phone Number *
How would you like to be identified? *
example: "Agent Dana Scully in Annapolis" or "Anonymous"
What question(s) do you have for your District 12 members? *
Do you want to sign up for any newsletters?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy