1. Get connected, stay connected

Please complete this short survey on social media. Your participation is greatly appreciated.

1. Title

2. First Name

3. Last Name

4. Home Address (so we can match you to your U.S. Representative)

5. City

6. State

7. ZIP

8. Preferred Phone Number

* 9. E-mail address (required)

* 10. Sign me up for the ASA Grassroots Network!

11. Do you participate in any of the following online networks?

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