Grasstops Information Form
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Please share information about your political relationship with an elected official.

1.

Which (Federal, State, or Local) elected official(s) do you have a relationship with?:

2.

Please describe your relationship (strength, length, etc.) with the elected official(s). What contact method would you feel most comfortable using to contact that individual on an issue specifically related to our organization?: 

3.

Last Time Contacted
Generally speaking, please estimate the timeframe (within the last month, 6 months, year, etc.) of your last contact with the elected official(s).:

4. Please select if you have done any of the following in the past 12 months:
5. Have you ever given money to a political campaign or to a Political Action Committee (PAC)?
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