NC MMB - Representative Contact Form
Questions marked by * are required.
1. Name: *
2. Email: *
3. Your county of residence
4. Which House member did you contact? (Use a separate form for each member contacted.)*
5. Describe method of contact with the Representative. Check all that apply.
  • Phone call with Rep
  • Phone call with Legislative Aide
  • Fax
  • Email
  • Letter
  • Visit in Raleigh
  • Visit in District office
  • Other
6. Feedback: Willingness to support bill? *
  • Willing
  • Refuses
  • Won't Commit
  • Did not discuss
7. Date of contact with Representative:
8. Contact me about advocacy work to get this bill passed! I want to help!
  • Yes
  • No
9. Message: