Advocates for Epilepsy

Contact Report Form

After your initial visit with your Member of Congress, AFE would like the following feed-back. When done, click on "Submit." This information will be shared only with those people associated with AFE.

The following information can also be sent to:
Debbie Flader, 2134 Baldwin Ct., Hanover Park, IL 60103

1) Specifically, whom did you meet with? (Please include name, address and phone).


2) If you met with a legislative aide, or other staff member, what is the name of the Member of Congress?


3) Please summarize details of your meeting. (Did you find your Member of Congress helpful?)


4) Action plan. Please list any action your Member of Congress has promised to take.