District Lobbying Day Registration Form

Please complete the District Lobbying Day registration form below after you have arranged your meetings. Providing this information will enable us to email you important updates and resources to assist you in having a successful District Lobbying Day. It will also enable us to assist your fellow PIA members who may be trying to arrange meetings with the same Representatives & Senators as you.

Should any important details change (e.g. a new meeting is scheduled, a meeting is canceled or a meeting's time/date change) after you have registered, please let us know via email at mikebe@pianet.org.

* Required

Your Information

Title

Mr.

Ms.

Mrs.

Miss

First Name*

Last Name*

Designations

Agency (Company) Name*

Address 1

Address 2

City

State*

Zip Code

Phone Number*

Fax Number

Email Address*

Meeting Information

Meeting #1: If you have arranged a visit with your United States Representative or a staff member, please provide the important details below: name of the person who you will be meeting with (if a staffer, the elected official they work for), where you will be meeting them (many representatives have multiple offices), the date and time of meeting.

Is there anything we should know about this meeting?

Can we share this meeting information and your contact information with your local PIA affiliate association and any fellow PIA members who may also be trying to coordinate meetings with this elected official?

Meetings #2/3: If you have arranged a visit with your United States Senator(s) or a staff member, please provide the important details below: name of the person who you will be meeting with (if a staffer, the elected official they work for), where you will be meeting them (many senators have multiple offices), the date and time of meeting.

Is there anything we should know about this meeting?

Thank you for completing the PIA District Lobbying Day registration form. Please click the Submit button below to send this information to the staff at PIA National. Should you want to print this form, please do so prior to clicking Submit. Thank you for taking part in District Lobbying Day.