I’ve Contacted My Legislator Form

Have you contacted your legislator?

Name (person filling out the form)*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
*
Yes, I contacted my legislator
Date of contact with your legislator
MM slash DD slash YYYY
Name of legislator:*
First Last
Type of contact made*
If you had a visit (or zoom meeting), did you speak with your elected representative, with staff or both?
If you had a visit (or Zoom meeting), please provide the names of legislative staff in attendance.
If you had a visit (virtual, phone call or Zoom meeting), please list the names of all in the meeting
Notes and overall impressions
If you had a visit or phone contact, did the representative seem familiar with the issues, have a positive or negative response and/or did they express support for a Licensed Midwife Board or not.
Is there any need for follow up with staff, please explain
If you had a visit or phone contact, did the representative have questions necessitating follow up, for instance more detailed information about the difference between LMs and CNMs?