Please complete this form to further participate in STS Advocacy efforts. Thank you for your leadership. Full Name Enter in your full name replacing what is in here. Email Phone Preferred Contact Method - Select -EmailPhone Home Address Home Address Home Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code If you have a personal or professional relationship with a member of the U.S. House of Representatives or Senate, please list it here: Have you participated in any of these political activities? Meeting with an elected official or staff Attended a town hall meeting Attended a political fundraiser None of the above Leave this field blank