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.

Legislator Name

Senator

If Senator Check, Provide District

Representative

If Representative Check, Provide District

U.S. Senator

If US Senator Check, Provide District

U.S. Representative

If US Representative Check, Provide District

Name

Agency Name

Member ID

Member Address

City

State

Zip

Best Contact Number

Please elaborate on the nature of your relationship (i.e. met in college, business associate, etc.