PAND Legislative Visit Reporting Form Question Title * 1. PAND District Central Lehigh Valley Northeast Northwest Philadelphia Pittsburgh OK Question Title * 2. PAND members attending the visit (list full names) OK Question Title * 3. Did you meet with a Federal or State Legislator? Federal State OK Question Title * 4. Did you meet with a Representative or Senator? Representative Senator OK Question Title * 5. List the full name of the Legislator you visited: OK Question Title * 6. List the full name of the person you met with including his/her title: OK Question Title * 7. Provide the date of the meeting: OK Question Title * 8. Provide the location of the meeting (e.g. Harrisburg or local office, town hall, etc.) OK Question Title * 9. What topics were covered during the meeting (you may use a bulleted list)? OK Question Title * 10. What materials did you leave behind? OK Question Title * 11. How was your message received? (e.g. if applicable, agreed to co-sponsor legislation?) OK Question Title * 12. Action items as a result of meeting (e.g. requested contact by AND or PAND, requested additional materials, etc.): OK Question Title * 13. Any additional feedback/comments regarding this meeting: OK DONE