2015 Grassroots Hill Appointments

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* 1. Legislator First Name:

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* 2. Legislator Last Name:

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* 3. State:

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* 4. District (select S for Senate candidate):

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* 5. Appointment Time:

Time

Time

AM/PM

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* 6. Meeting Location Building:

Cannon

Longworth

Rayburn

Russell

Dirksen

Hart

Capitol

Other (please specify)

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* 7. Meeting Location Room:

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* 8. Meeting with:

Member

Staff

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* 9. If meeting with staff, staff name:

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* 10. AIA Members Attending (If more than 4 attending, email attendance list to amandastratton@aia.org):

Member 1:

Member 2:

Member 3:

Member 4: