Form
Name
*
First Name
Last Name
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Email
*
example@example.com
Please list any dietary restrictions you have?
What are some questions you would like our legislators to answer?
Are you a constituent of Senator Hesselbein?
Yes
No
Are you a constituent of Senator Ratcliff?
Yes
No
Are you a constituent of Representative Subeck?
Yes
No
I understand that photos/video may be taken during the event and shared on social media or promotional materials.
*
Yes
No
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