Please tell us about your HB 1722 contact with your legislator

(fill out a separate form for each contact)

About You: Name: Street: City:   MAAKALARAZCACOCTDCDEFLGAHIIAIDILINKYKSLAMDMEMIMNMOMSMTNENHNCNDNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY   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: Legislator Senior Staffer Legislative Aid Receptionist N/A - sent email/letter   How did you contact your Legislator: By phone Sent email Sent letter In person meeting   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 HB 1722?     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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