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Follow Up/Report Back to UMDF
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1.
Please tell us about you
(Required.)
Name:
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Address:
Address 2:
City/Town:
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State:
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AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code:
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Email Address:
Phone Number:
2.
How many of the UMDF's Grassroots Advocacy Efforts did you undertake for the week of February 15-18 2010
One
Two
Three
3.
Tell us which of the advocacy efforts you completed during the week of February 15-18th, 2010. Check all that apply.
I phoned my Congressman seeking HR 3502 co-sponsorship
I phoned my U.S. Senators seeking S. 2858 co-sponsorship.
I used the UMDF's Adovcacy Action Center and sent letters.
I visited both of my U.S. Senators
I visited by Congressman/Congresswoman
I visited one of my U.S. Senators
4.
Did your meeting produce a commitment from the elected official that he/she would agree to cosponsor H.R. 3502 or S. 2858?
No, there was no commitment for H.R. 3502
Yes, my Congressman/Congresswoman will cosponsor H.R.3502
No, there was no commitment for S. 2858.
Yes, my Senator will cosponsor S. 2858
If yes, tell us who agreed to cosponsor
5.
Tell us the name and position of the person you met with and their office (ex. Joe Smith, Legislative Aide, Congressman John Public)
6.
Tell us about your success. If you had a meeting, share the details with us. If you made a phone call, tell us what was said.
7.
Would you like us to share your comments on our 'Advocacy Successes" Page at umdf.org?
Yes, I give you my permission to use my story and name
No
Other (please specify)
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8.
Does your Visit/Call/Letter require any follow up with the elected official from the UMDF National Office? If so, please tell us who to contact and the information needed.
(Required.)
9.
Did you undertake any other Advocacy Activities ( asking friends to send letters, make calls or visit)? Please describe:
10.
The UMDF Is forming a National Advocacy Grassroots Committee to help mobilize our efforts. Would you be interested in being part of this effort?
Yes
No
11.
What are the two best ways to communicate with you? (Please indicate only first and second preference)
First Preference
Second Preference
Email
Telephone
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