Hiatt for Senate

I want to hear your story.

As your Senator, I have the courage to speak up and not only tell my story, but your story too! I'm interested in the barriers you face, the hopes you have and the ways that I can serve and represent you in Pierre. Please take a moment to tell me your story!

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* 1. What is your first name?

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* 2. What is your story? What would you like me to know?

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* 3. How could I best represent you in Pierre?

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* 4. Generally speaking, do you consider yourself a Republican, Democrat, Independent or something else?

Republican

Democrat

Independent

Other

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* 5. Are you a registered voter?

Yes

Unsure / Don’t know

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* 6. What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 7. Contact Information (optional)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number