Please use this form to let us know about any visits to U.S. Senators' or Representatives' offices where you discussed the Breastfeeding Promotion Act of 2011. If you visited more than one Congressperson, please complete the form separately for each visit.

* 1. Senator's or Representative's Name:

* 2. Please check one:

* 3. This Congressperson is:

* 4. Contact made with:

* 5. Staffer/Aide Info:

* 6. Your Info:

* 7. Name(s) of Any Others Attending this Appointment:

* 8. Type of Contact Made (check all that apply):

* 9. Interest in co-sponsoring the Breastfeeding Promotion Act:

* 10. Other Issues Discussed (Please note whether they agreed/opposed/were neutral):

* 11. Specific Outcomes of Contact:

If you have not already, please send a thank you note. A sample thank you letter can be downloaded from the conference presentation handouts page (see Session D1):
2010 NCSBC Presentation Handouts