Please fill out this form for EACH meeting you have scheduled with a member of Congress. Once you submit your first form, it will automatically re-open so you can submit additional visit(s) information or you can return to the link anytime to enter another visit at https://www.surveymonkey.com/r/2026VirtualVisits.

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* 1. Your Name

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* 2. Phone Number

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* 3. Please enter your Email Address:

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* 4. Name of your GPA Chapter (if applicable)

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* 5. Congressional Office You’re Visiting: (including member of Congress’ name, state and district number if applicable)

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* 6. Please indicate the date of your meeting.

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* 7. Are You Meeting With (check all that apply)

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* 8. If Staff, please provide the name and title:

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* 9. How many chapter members are attending?

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* 10. Please list on separate lines the name and email address (if available) of each chapter member planning to attend:

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