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Please tell us about your contact with your legislator in support of "An Act Relative to Gender-Based Discrimination and Hate Crimes"

(please fill out a separate form for each contact)

About You:

Name:
Street:
City:     Zip:   +4:
Email:
Phone:
  May we contact you if further information is needed?   Yes   No
  Name we should use if we contact you:  
  Are you a registered voter?   Yes   No

About the legislative office you contacted:

  Name of Legislator:
  Date of contact:
  Who you made contact with:
  How did you contact your Legislator:
  If you sent an email, letter, or left a phone message:
    Have you received a reply?   Yes   No
    If yes, please describe:
   
  If you spoke with a Staff Person, please describe what happened:
   
  If you spoke with your Legislator, please describe what happened:
   
  Will the legislator support "An Act Relative to Gender-Based Discrimination and Hate Crimes"?
    Yes   No   Need more information   Non-Committal
  Would the legislator or their office like any other follow up materials? If so, what kind?
 
  Any other comments?
 

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