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Political Outreach Report Form

Please fill out this form after you meet with a member of Congress. Thank you.

Your Name:
Your E-mail Address:
Mars Society Chapter:
Legislator's Name:
Legislator's Office:
State:
Outreach Date: ,
Type of Outreach:
If  a meeting occured, where:
Was the legislator present?
Was an aide present?
Aide's Name:
 (if present at meeting)
Members Present:
Report/Summary: