WiAHC Key Contact Program

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WiAHC Key Contact Program
Your response to the questions below will help us in our communications with members of the Wisconsin Legislature. We appreciate the time you are taking to respond to this short survey. Your help is invaluable as we work to ensure our voice is heard in the state capitol.

Don’t know your legislators? Look them up here by providing your address (work or home).

Members - You may login before filling out the form in order to pre-populate membership fields.

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Member Legislator Information
The name of my Wisconsin State Senator is: *
My relationship with my state senator is best described as: *	Very Good Good Fair None
My connection to my state senator is: *	Social Acquaintance Neighbor Member of Same Organization Attend School together Childhood Friend Business Acquaintance Other (please list below) Contributed to his /her campaign Represents my district None
Other connection with State Senator:
The name of my Wisconsin State Representative is: *
My relationship with my state representative is best described as: *	Very Good Good Fair None
My connection to my state representative is: *	Social Acquaintance Neighbor Member of Same Organization Attend School together Childhood Friend Business Acquaintance Other (please list below) Contributed to his /her campaign Represents my district None
Other Connection with State Representative
Do you know any other current members of the Wisconsin Legislature? *	Yes No
If yes, the name of that legislator(s) is:
My relationship with that legislator is best described as:	Very Good Good Fair None
How do you know this legislator?	Social Acquaintance Neighbor Member of Same Organization Attend School together Childhood Friend Business Acquaintance Other (please list below) Contributed to his /her campaign
Other connection with legislator
Are you willing to write letters/make phone calls to your elected officials, if requested? *	Yes No
Have you ever testified before an Assembly or Senate Committee? *	Yes No

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Wisconsin Association forHome Health Care

Wisconsin Association for
Home Health Care