Rep. Erik Simonson - 2016 Legislative Survey Question Title * 1. Please enter your address and contact info to verify your residence.This information is confidential and will not be shared or used for any other purpose. Name (First and Last) * Address * Address 2 City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 2. Would you like to receive weekly email updates during session from Rep. Simonson? Yes No Write email address here if not noted above Next