PSA Legislative Champions Sign Up
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Name
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Title
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Home Address
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City
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State
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Zip Code
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Home Phone
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Cell Phone
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Email Address
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What is the best way to contact you? (check all that apply)
Do you have a relationship with any Pennsylvania State Representatives and/or Pennsylvania State Senators?
Please describe the relationship you have with the either the State Representative or State Senator
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Are you willing to contact your Pennsylvania State Senator or State Representative as needed?
Would you be willing to attend fundraisers on behalf of the PSA?
Would you be willing to attend in person meetings with your Pennsylvania State Representative or State Senator?
Would you be interested in a PSA legislative App for your smartphone?
Are you on social media? (check all that apply)
What can we do to get you involved in advocacy?
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