OML Grassroots Email Enrollment Form

GRASS ROOTS INVOLVEMENT PROGRAM (GRIP) ENROLLMENT FORM

In an effort to have a favorable outcome on legislation involving cities and towns, this program has been created for key municipal leadership actively involved in the legislative process.

The GRIP program will allow us to make quick contact with you, who in turn, can make quick contact with your legislator(s) on issues of importance to you during the legislative session. Whenever a contact needs to be made, you will be notified. These issues often turn on a few hours’ notice. When contacted, you will receive all the information that you will need on the issue via email. In critical situations, we may also reach out by phone.

First Name *

Last Name *

Title *

Municipality *

Email Address *

Mailing Address: *

City *

State *

Postal Code *

Business Phone *

Cell Phone (Optional)

Please describe the relationship that you have with state/federal officials whether or not he/she represents your city or town. (How Well Known Answers 1-exceptionally 2-very well 3-well 4-not well)

	Name and Office	How well known?	Relationship
1	Name and Office	How well known?	Relationship
2	Name and Office	How well known?	Relationship
3	Name and Office	How well known?	Relationship
4	Name and Office	How well known?	Relationship
5	Name and Office	How well known?	Relationship

Issues that are of special interest to you: *