2013 Capitol Hill Visit Feedback

Capitol Hill Visit Feedback Form Spring 2013

You have two goals when you visit with Representatives, Senators, or their staff: (1) to educate them about a particular issue and (2) to gather intelligence as to Congressional thinking on an issue. Feedback from your Congressional Hill visits is an important part of ANCOR’s grassroots efforts. The more information you provide to ANCOR, the more effective our advocacy.

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* 1. ANCOR Member Contact Information

Name (required): *

Company (required): *

Address:

Address 2:

City/Town (required): *

State (required): *

ZIP:

Email Address:

Phone Number:

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* 2. Please provide information on the Senator, Representative, or staff member visited.

Representative or Senator Name (required):

State (required):

Meeting date (required):

Staff member name (if applicable):

Staff's title:

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* 1. ANCOR Member Contact Information

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* 2. Please provide information on the Senator, Representative, or staff member visited.

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* 3. Did you visit a Senator or a Representative (or their staff)?