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1. Your Contact Information

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2. State(s) you represented

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3. Name of Senator or Representative you met with

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4. Name of Person(s) you met with

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5. Bill(s) or Issue(s) Discussed

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6. Comments of Note from Senator, Representative, or Staff Member(s)

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7. Should ANCOR Follow-Up with the Office?

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8. Attach any Images, News Articles or anything else related to the meeting

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