Legislative Advocacy Support Fund Request Form

Your Name:  

Date of Request:

Type of activity you will be participating in:

Meeting with legislators, their staff, or other policymakers    

please specify:

Testifying before legislative committees

please specify:

Attending legislative hearings

please specify:

Participating in planning meetings directly related to the activities listed above

please specify:

Other activities related to educating & informing legislators & other policymakers    

please specify:

Support needed to participate in this activity:

Services will be provided by (if known)

Cost of this service (estimate if necessary)

Address

City   State   Zip

Daytime Telephone     Email