KPhA Legislative Visit Report
Thanks for helping to educate our state legislators on the important issues facing our profession. Help us build a cohesive voice by letting us know how the visit went and if there's any follow up needed.
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Date of the visit
-
Month
-
Day
Year
Date
Legislator (or candidate) name
*
First Name
Last Name
Additional legislator name
First Name
Last Name
How well do you think the visit went? (1 would be they hated your message and think pharmacies suck, 5 is they are ready to go to bat for you.)
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Short description of topics addressed and anything else KPhA needs to know about the visit
Does KPhA need to follow up with this legislator on something specific - questions needing answered, material to be sent?
Yes
No
Let KPhA know what to do to follow up with the legislator
Does KPhA need to follow up with the legislator
Please call me
Please call the legislator
No follow up needed
Please let Jared know a good number he can reach you at this week
Please enter a valid phone number.
Submit
Should be Empty: