Everyone Knows Someone!
Political Contact Information Sheet

Find your Senator
Find your Representative

Please distribute this form to every person in your agency and ask if they have a relationship with any legislator. Those who do should complete a SEPARATE form for EACH legislator with whom they have a relationship.

*Name of Legislator:  
       
District #: District #:
       
District #: District #:


Please fill in the information requested below. Fields with an * are required.
*Name:  
*Agency Name:  
*Job Title:  
*Member ID:  
*Mailing Address:  
*City:  
*State:
*Zip:  
*Work Phone:  
*Cell Phone:  
Fax:
*Email:    
Please elaborate on the nature of your relationship (i.e. met in college, business associate, etc.)
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