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Congressional Visit Debrief Form

First Name

Last Name

Office Visited:

Senator

Representative

State

Senator or Representative First Name

Senator or Representative Last Name

Who did you meet with in the office?

Does the Senator, Representative or staff have any personal connection to nursing (i.e. family member or friend who is a nurse)? Please explain.

Describe any feedback that the Senator, Representative or staff provided on the legislative issues.

Describe any concerns or questions raised by the Senator, Representative or staff.

Do you have any additional comments?