Public commitment form - Do Not Stand Idly By

Please add my name
Please add my name.
Instructions I agree to be listed on the Request For Information to be submitted to gun manufacturers by officials from jurisdictions across the United States.
Yes, contact my office.
Yes, contact my office.
Official's name *
Title *
Jurisdiction *
Email *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Staff contact name
Staff email
Staff phone