Use this form to let The Michael J. Fox Foundation know when you've meet with or called your members of Congress. This information will help inform our public policy and advocacy efforts. 

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* 1. What is your name?

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* 2. What's your email address?

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* 3. What state do you live in?

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* 4. What is your congressional district?

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* 5. Met/spoke with the office of:

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* 6. I met or spoke with:

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* 7. Anything you would like to share from the meeting?

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* 8. Did the member/staff express any personal connection to Parkinson's disease (or any other disease)? If yes, what was the connection?

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