* 1. Your Name:

* 2. Your e-mail/contact information:

* 3. August Recess Activities Completed (check all that apply)

FOR MEETINGS

* 4. Met with (Name):

* 5. Member of Congress (Name):

* 6. Meeting Date:

* 7. Was the Member/staff supportive of protecting biomedical research?

* 8. Did the Member/staff express any personal connection with Parkinson’s disease and/or another neurological disorder? If yes, what was the connection? Any other notes?

* 9. Did the Member/staff request any additional information or does anything you discussed in the meeting require follow-up from PAN staff to the Member’s office?

* 10. Did any other issues arise in your meeting?

FOR LETTERS TO THE EDITOR

* 11. Was your Letter to the Editor published?

* 12. If yes:

FOR TOWN HALL MEETINGS

* 13. Did you attend an in-person or tele-town hall meeting?

* 14. Were you able to ask if your Member supports biomedical research funding?

* 15. Did your Member express support for biomedical research funding?

* 16. Did any other issues arise in the town hall meeting? Please explain.

OTHER

* 17. Other actions taken? Please explain.

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