Interest Survey
We would like to connect with you on specific needs that align with your interests and the type(s) of advocacy you like to do!  It will also help us to reach out directly to constituents when specific members of the NC General Assembly need extra contact.  All information will be held in confidence, only to be used by NC NORML chapters.
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Email *
1. First Name *
2. Last Name *
3. Best Way for Us to Contact You (for rapid response needs as well as to inform you of meetings, events, etc.) *
4. Phone Number *
5. City/Town *
6. Zip Code *
7. Who is Your NC House Representative? (Don't know? Look them up here: or here: *
8. Does Your Representative Support? *
9. Who is Your NC Senator? (Don't know? Look them up here: or here: *
10. Does Your Senator Support? *
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