Enews/Survey Lightbox





Refresh Number

*By answering this survey, you are subscribing to my newsletter.

CODE

  • HIDDEN_WEBSITE_VARIABLES

     

    How to use: Insert <span class="EXACT_VALUE_LABEL_AS_ENTERED_BELOW">&nbsp;</span> where you'd like the value to be populated.

    Non-breaking space within span tags - &nbsp; - is required for WYSIWYG.

    Label
    (no spaces or special characters)

    Value

    		 Comments (optional)
    repName John Smith  
    helpWithFedAgencyAddress Haverhill District Office
    1234 S. Courthouse
    Haverhill, CA 35602    		  
    district 21st District of California  
    academyUSCitizenDate July 1, 2012  
    academyAgeDate July 1, 2012  
    academyApplicationDueDate October 20, 2012  
    repStateABBR AZ  
    repDistrict 1  
    repState Arizona  
    repDistrictText 1st  
    repPhoto  
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills  
         
         
         
         
         

  • Office Locations

    Office Name Location Image Map URL
    Washington DC 1124 Longworth HOB
    Washington, DC 20515
    Phone: (202) 225-5731
    Fax: (202) 225-3307    		   https://goo.gl/maps/kVjDNPYhXAA2
    Painesville Office

    1 Victoria Place,
    Room 320
    Painesville, OH 44077
    Phone: (202) 333-4455
    Fax: (202) 333-5522    		   https://goo.gl/maps/VgGAwCd5x4S2
    Mentor Office 8500 Station Street
    Suite 390
    Mentor, OH 44060    		   https://goo.gl/maps/Y7zdm3oG4RK2
           
           

Facebook Posts

Sign up for my E-Newsletter

Take my Survey