Congressional Visit/Local Event Report Form
Please complete this form if you met with your member of Congress at home, participated in a town hall meeting, or attended another local event hosted by your Senators/Representative.
Who Did You Visit? *
First & Last Name of Senator/Representative Visited *
Your answer
What Kind of Activity Did You Participate In? *
If You Participated in A Meeting, List Names of All Participants *
Your answer
Where Did the Visit/Meeting/Town Hall/Etc. Take Place (list city/state)? *
Your answer
What Did You Discuss (briefly list main topics)? *
Your answer
Summarize the Reaction/Comments From Your Senator/Representative to Topics Discussed
Your answer
Your Name *
Your answer
Your Email Address *
Your answer
Your Telephone Number
Your answer
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