Congressional Appointment Confirmation Form

AOTA Capitol Hill Day September 30, 2013 Congressional Appointment Confirmation Form

Please list the appointments you have made for Capitol Hill Day. If more than one person is meeting with the Legislator/Staff, please list all those who are attending the meeting(s), if you have that information. Use as many pages as you need. Return form to: [email protected], fax 301-652-7711, or mail Darlene Dennis, AOTA, PO Box 31220, Bethesda, MD 20824-1220. Call if you have questions or need help: 1-800-SAY-AOTA ext. 2014. This information will help us as we prepare materials and to help coordinate meetings with the same offices.

Attendee Name(s): ______

(attach another page if needed) ------

Legislator Name: ______

Staff Name: ______

Confirmed Appointment Time: ______

Meeting Location: ______

Legislator: ______

Staff: ______

Legislator: ______

Staff: ______