Tell Us About You!

I'm happy to get to know the constituents and community groups out here in the 96th Legislative District!

Please take a moment to tell us about yourself with this quick survey!

Tell us about the events you’d like to attend and on what topics: townhalls, small business, seniors, veterans, children’s, volunteer, and other.

Which days of the week and times of day would you prefer to attend an event?

Would you prefer to attend the events in-person or virtually?

Which legislative issues interest you: safety, education, environmental, housing, health, hospitality/tourism, workforce, transportation, LGBTQIA, and other.

What are the top 2 aspects of life in your community that you enjoy the most?

Comments, Questions, and/or Suggestions:

Would you like to be kept informed on state government issues?

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Please provide the following information:

Full Name:* First Name:*

Last Name:*

Email Address: *Email: *

Phone Number: *Phone: *

Address: *

City: *

State: *

Zip Code: *