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Required information
Contact Information
*
Organization:
(Please type of the name of the organization meeting with the Congresswoman.)
*
Street Address:
Street Address2:
*
City:
*
State:
*
Zip Code:
-
*
Organization Contact:
*
Title:
*
Work Phone:
*
Cell Phone:
*
Home Phone:
*
E-Mail Address:
Meeting/Event Details
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General Topic/Issue:
*
Location:
Please Choose
DC Area
Chicago Area
Other
*
Event Date:
*
Event Time:
*
Description
:
Please include relevant legislation and specific topics you intend to discuss with the Congresswoman.
*
Attendees
:
Please type the names and titles of all attendees and indiciate if they are from Illinois's 11th Congressional District.
*
Previous Meeting?
Have you met with the Congresswoman before?
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