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Meet With Your Elected Officials
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Meet With Your Elected Officials
Meet With Your Elected Officials
Legislator Meetings - Registration Form
Name
(Required)
First
Last
Home Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Practice Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Practice Name
(Required)
Phone
(Required)
Email
(Required)
Select your District Dental Society:
(Required)
Minneapolis District
Northeastern District
Northwestern District
Saint Paul District
Southeastern District
Southern District
Student District
West Central District
I want to schedule a meeting with my (select as many as needed):
(Required)
Representative – Home Address
Senator – Home Address
Representative – Business Address
Senator – Business Address
Which meeting format do you prefer (select as many as needed):
(Required)
In-Person – In District
In-Person – At State Capitol
Virtual
What is the best general availability for you (select as many as needed):
(Required)
Morning
Afternoon
Evening
Weekend
Is there anything specific you want to discuss with your legislator?
Is there anything the MDA should consider when helping to schedule your meeting?