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* 1. Name

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* 2. Email Address

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* 3. What State Chapter are you affiliated with?

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* 4. How do you prefer to make appointments with your Congressional delegation?

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* 5. If you need assistance scheduling appointments, which Congressional offices would you like to visit?

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* 6. What issues are most important to you that you would like to discuss?

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* 7. Have you ever been to Capitol Hill?

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* 8. Will you need accommodations for mobility issues?

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