Member Name:

I can be contacted at:

E-mail:

Phone (add area code):

Address:

Statement of Request, Question, Concern, Idea or Proposal:

Additional Details or Supporting Rationale:

*Special Note on Communcations for Board of Directors or House of Delegates:
If you are proposing a specific policy action for consideration at a Board of Directors quarterly meeting, or a resolution for the House of Delegates annual April meeting, please state in your own words the key points that the policy action or resolution should include.

**If your request, question, concern, idea or proposal is confidential, and if you would like to communicate with a staff member directly, please contact Diane Stampfli or call 608.442.3800.

For a printable version of the form, click here.