Federal Legislative Reporting
Use this form to report activity with your FEDERAL legislator. This includes meetings in your district, in Washington DC, fundraisers or other campaign events. Please complete a new form for every meeting. For questions about this form please contact OPW-Federal-Team@eyes.org
Sign in to Google to save your progress. Learn more
Email *
Your Name *
Federal Legislator interacted with:  *
Date of meeting  *
MM
/
DD
/
YYYY
Place of meeting  *
Who attended the meeting from the legislator's office?  *
List any other doctors that attended the meeting with you.
What was the nature of meeting/event (example: campaign event, AOA on Capitol Hill, in-district meeting, town hall)?  
 *
Were PAC or personal campaign donations left?
 *
If so, what was the amount of financial support? 
Topics Discussed: 
 *
What comments did the legislator have? 

Does someone from AOA need to contact this legislator? If so, please explain.
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

Google Forms