Advocate Feedback

Below is the Advocate Feedback Form for you to fill out after meeting with your MP. This form is very important for JDRF as we move forward with our relationship with the MPs in Ottawa.

Advocate Feedback Form

*Name of official

*Constituency:

*Level of Government:  Federal
 Provincial
 Municipal

*With whom did you speak to?

 Elected official
 Assistant
Assistant's Name:

 

*Your Name:

*Your E-mail:

*Name of Individuals who attended the meeting:

Does the Member/Assistant have any personal connection to diabetes?

 Yes

 No

Is there any other information we should know?

Is there any follow-up necessary?

 Yes

 No

If yes, by whom?

Additional Comments:

 

* Required Fields

You can view our Privacy Policy to see how we use the information we collect.

Lets turn type one into type none