Restore Fair Access: Interest Form

First Name*

Last Name*

Business or Organization*

Organization Scope*

National

Regional (please specify region):

Industry-specific (please specify industry):

Supplier:

Focus Area*

What is the general focus of your organization or business.

Interest*

Interested in Partnering

Ready to Be a Partner Today

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Other (explain in comments)

Do you want a Local Impact Sheet for your Congressional District or State

If you want a Local Impact Sheet sent to you for your Congressional District and State, include your state and Congressional District below. We will send these to you.

Website*

Email*

Phone*

Address*

City*

State*

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Intake Comment*

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