Submit A Question for Congressman Allen West

Small Business Empowerment Forum | Ft. Lauderdale | May 20, 2011

Please use the form below to submit your question for U.S. Rep. Allen West and/or Florida Senate President Mike Haridopolos.

If you would like to ask your question in person, click here to register.

Question Title

* 1. Question Submitted By:

First Name *

Last Name *

City

State

E-mail Address

Question Title

* 2. Unless you indicate that you would like to remain anonymous, your first name, last initial and city/state will appear with your question.

I would like to remain anonymous

Question Title

* 3. Are you currently a Member of the Alliance for Affordable Services?

Yes

Submit A Question for Congressman Allen West

Small Business Empowerment Forum | Ft. Lauderdale | May 20, 2011

Question Title

* 1. Question Submitted By:

Question Title

* 2. Unless you indicate that you would like to remain anonymous, your first name, last initial and city/state will appear with your question.

Question Title

* 3. Are you currently a Member of the Alliance for Affordable Services?

Question Title

* 4. If you are an Alliance Member, please provide your Member Number (it is 12 characters long)- NOT REQUIRED

Question Title

* 5. Please use the box below to enter your questions to U.S. Rep. Allen West and/or Florida Senate President Haridopolos.