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Please provide as much information as possible regarding your contact or visit with a U.S. Senator or U.S. Representative or a member of their Congressional Staff using the form below. A copy of this report will be sent to you at the email address you provide below, as well as to the appropriate recipients based on the selected State or Territory.
Fields marked with * are required and must be provided in order to submit the Contact Report.


Contact Information

Congressional Name:*
Enter the full name of the Senator or Representative, even if the contact was with a staff member.

 
 Leadership Indicates that the congressional member is in a congressional leadership position
 Freshman Class Indicates that the congressional member is part of the freshman class (serving their first term)

 
Membership on Congressional Committees having ITA/CS oversight

 
Senator    Indicates that the congressional member serves in the Senate
Select a Senate committee on which this congressional member serves, if appropriate; otherwise, select None

 
Representative    Indicates that the congressional member serves in the House of Representatives
Select a House committee on which this congressional member serves, if appropriate; otherwise, select None

Party: *
Select the political party affiliation of the congressional member
State/Terr: *
Select the state or territory represented by the congressional member
Representative District: *
If the congressional member is a Representative, select the district they represent in their state or territory
Congressional Code:   

Staffer Full Name:  
If contact was with a staffer for the congressional member, enter their full name; otherwise leave blank

Staffer Title:  
Select the office title for the staffer from available entries, or select Other and enter title in the text field
Other:*
If an appropriate entry is not available in the options for Staffer Title, enter their title in this field



Date of Visit/Contact:*
Popup Calendar Enter the date of the visit or contact

Place/Location/Event:  
Enter a brief description of the place, location, or event of the contact

Key Issues / Discussion Topics

Issue #1:  
Select the first issue discussed
Rank:  
Indicate the position of the congressional member on the first issue

Issue #2:  
Select the second issue discussed
Rank:  
Indicate the position of the congressional member on the second issue

Issue #3:  
Select the third issue discussed
Rank:  
Indicate the position of the congressional member on the third issue

Other Issue(s):  
Enter a brief description of any additional issue(s) discussed
Rank:  
Indicate the position of the congressional member on the other issue(s)



Your Information

Full Name:*
Enter your full name
Member of DEC:*
Provide details of your DEC membership

DEC Member Phone:  
Provide your phone number, if desired
DEC Member Email:*
Provide your email address to receive a summary of your submitted contact report



Additional Details

Remarks:  
Provide any additional remarks about your contact that might be helpful or clarify details above

Follow-Up:  
Provide any comments about follow-up contact or actions that might be required or beneficial