Legislative Key Contact Program

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Are you willing to write letters/make phone calls to elected officials, if requested?

Are you willing to write letters/make phone calls to elected officials, if requested? Yes No
Have you ever testified before a legislative committee?

Have you ever testified before a legislative committee? Yes No
Your State Senator Information
State Senator Name State Senator Name First Last
My relationship (if any) with my State Senator is:
Your State Representative Information
State Representative Name State Representative Name First Last
My relationship (if any) with my State Representative is:
Other member of the Maryland Legislature you personally know.
Representative/Senator Name Representative/Senator Name First Last
Relationship to Legislator
Legislator Name Legislator Name First Last
Relationship to Legislator