Kansas Legislative Meeting Feedback Form

Kansas Legislative Meeting Feedback Form

Please submit one survey for each legislator. Thank you!

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* 1. Name

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* 2. Organization/Provider

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* 3. City/Town

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* 4. Zip Code

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* 5. Email Address

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* 6. Name of legislator you met with

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* 7. What issues did you discuss?

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* 8. Any other comments you want to add?

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* 9. Does InterHab need to follow up?

Yes

No

If yes, please provide details about what follow up is needed.

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* 10. If you took a photo with you legislator, please upload here:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.