PSPA Legislator Form

Back to Get to know your Legislator

Please print and mail this page while we develop our on line submission form

Get to know your Legislator

Name:	_______________________________________________________________
Address:	_______________________________________________________________
	_______________________________________________________________
Home Phone:	_______________________________________________________________
Work Phone:	_______________________________________________________________
Email Address:	_______________________________________________________________
Legislator's Name:	_______________________________________________________________
Any Previous Contact:	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________

Please complete and mail to:

PSPA
P.O. Box 128
Greensburg, PA 15601