gwenmoore.house.gov
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Submitted URL: http://gwenmoore.house.gov/contact/meeting-request.htm
Effective URL: https://gwenmoore.house.gov/contact/meeting-request.htm
Submission: On April 25 via manual from IN — Scanned from DE
Effective URL: https://gwenmoore.house.gov/contact/meeting-request.htm
Submission: On April 25 via manual from IN — Scanned from DE
Form analysis 5 forms found in the DOM
/search/
<form class="search-form" role="search" action="/search/">
<div class="input-wrap">
<label class="hidden" for="search1">Search</label>
<input type="search" id="search1" name="q">
</div>
<button type="submit"><span class="icon-search"><span class="hidden">Search</span></span></button>
</form>/search/
<form class="search-form" role="search" action="/search/">
<div class="input-wrap">
<label class="hidden" for="search2">Search</label>
<input type="search" role="search2" name="q">
</div>
<button type="submit"><span class="icon-search"><span class="hidden">Search</span></span></button>
</form>Name: contact — POST /submit-meeting.aspx
<form action="/submit-meeting.aspx" class="meetingform" id="form" method="post" name="contact">
<fieldset>
<legend>Contact Information</legend>
<table cellpadding="0" cellspacing="3">
<colgroup>
<col width="150">
<col>
</colgroup>
<tbody>
<tr>
<td><strong>Prefix *</strong><br>
<input maxlength="90" name="required-prefix" required="required" size="30" title="Prefix" type="text">
</td>
</tr>
<tr>
<td><strong>First Name *</strong><br>
<input maxlength="90" name="required-first" required="required" size="30" title="First Name" type="text">
</td>
</tr>
<tr>
<td><strong>Last Name *</strong><br>
<input maxlength="90" name="required-last" required="required" size="30" title="Last Name" type="text">
</td>
</tr>
<tr>
<td><strong>Suffix</strong> <small>(Jr., Sr.)</small><br>
<input maxlength="90" name="suffix" size="30" type="text">
</td>
</tr>
<tr>
<td><strong>* Street Address </strong><br>
<input maxlength="190" name="required-address" required="required" size="30" title="Address" type="text">
</td>
</tr>
<tr>
<td>
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td>
<strong>* City </strong><br>
<input maxlength="30" name="required-city" required="required" size="30" title="City" type="text">
</td>
</tr>
<tr>
<td>
<strong>* State</strong><br>
<select name="required-state" required="required">
<option></option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option selected="selected" value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</td>
</tr>
<tr>
<td>
<strong>* Zip</strong><br>
<input maxlength="5" name="zip5" onblur="f(this)" onclick="f(this)" onkeydown="f(this)" onkeyup="f(this)" required="required" size="5" title="Zip Code" type="text">
<input maxlength="4" name="zip4" onblur="f(this)" onclick="f(this)" onkeydown="f(this)" onkeyup="f(this)" size="4" type="text">
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td><strong>* Email </strong><br>
<input maxlength="100" name="required-email" required="required" size="30" title="Email Address" type="text">
</td>
</tr>
<tr>
<td><strong>* Organization Name </strong> <br>
<input maxlength="190" name="org" required="required" size="30" type="text">
</td>
</tr>
<tr>
<td><strong>* Contact Phone Number </strong><br>
<input maxlength="100" name="mphone" required="required" size="30" title="Mobile Phone Number" type="text">
</td>
</tr>
<!--<tr>
<td><strong>Phone (Office) </strong><br />
<input maxlength="100" name="ophone" size="30" title="Office Phone Number" type="text" /></td>
</tr>-->
</tbody>
</table>
</fieldset>
<fieldset>
<legend>About the Meeting</legend>
<table cellpadding="0" cellspacing="3">
<tbody>
<tr>
<td><strong>* Available Dates and Times </strong><br>
<textarea name="dates" required="required" rows="3" style="width: 100%;" title="Available Dates and Times"></textarea>
</td>
</tr>
<tr>
<td><strong>* Location: </strong><br>
<select id="location" name="location" required="required" title="Location">
<option selected="selected"></option>
<option value="DC">DC</option>
<option value="Milwaukee">Milwaukee</option>
</select>
</td>
</tr>
<tr>
<td><strong>* Names and Hometowns of Attendees </strong><br>
<textarea name="attendees" required="required" rows="3" style="width: 100%;" title="Attendees"></textarea>
</td>
</tr>
<tr>
<td valign="top"><strong>* Specifically, what topics do you wish to discuss? </strong><br>
<textarea name="details" required="required" rows="7" style="width: 100%;" title="Topics to Discuss"></textarea>
</td>
</tr>
<tr>
<td>
<div id="response"> </div>
</td>
</tr>
</tbody>
</table>
</fieldset>
<table align="left">
<tbody>
<tr>
<td>
<center></center>
<div style="margin:5px 0; clear: both;">
<script src="https://www.google.com/recaptcha/api.js" async="" defer=""></script>
<div class="g-recaptcha" data-sitekey="6Le2KP8SAAAAAA38fpHcO6WgjGaZZrtSNyxfzxkm">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6Le2KP8SAAAAAA38fpHcO6WgjGaZZrtSNyxfzxkm&co=aHR0cHM6Ly9nd2VubW9vcmUuaG91c2UuZ292OjQ0Mw..&hl=de&v=4PnKmGB9wRHh1i04o7YUICeI&size=normal&cb=n3werf3o8swx"
width="304" height="78" role="presentation" name="a-8y5ye6sdiaau" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<noscript>
<div>
<div style="width: 302px; height: 422px; position: relative;">
<div style="width: 302px; height: 422px; position: absolute;">
<iframe src="https://www.google.com/recaptcha/api/fallback?k=6Le2KP8SAAAAAA38fpHcO6WgjGaZZrtSNyxfzxkm" frameborder="0" scrolling="no" style="width: 302px; height:422px; border-style: none;">
</iframe>
</div>
</div>
<div style="width: 300px; height: 60px; border-style: none;
bottom: 12px; left: 25px; margin: 0px; padding: 0px; right: 25px;
background: #f9f9f9; border: 1px solid #c1c1c1; border-radius: 3px;">
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid #c1c1c1;
margin: 10px 25px; padding: 0px; resize: none;"> </textarea>
</div>
</div>
</noscript>
</div>
<input type="submit" value="Submit Request"> <input type="reset" value="Reset">
</td>
</tr>
</tbody>
</table>
</form>/forms/emailsignup
<form class="signup-form" action="/forms/emailsignup">
<div class="row"><label class="hidden" for="email3">Email Address</label><input type="email" placeholder="Enter Email Address" name="email" id="email3"></div>
<div class="row"><button type="submit">Submit</button></div>
</form>/forms/emailsignup
<form class="signup-form" action="/forms/emailsignup">
<div class="input-wrap">
<label class="hidden" for="email4">Email Address</label>
<input type="email" class="email" id="email4" name="email" required="required" placeholder="Enter Email Address">
</div>
<button type="submit">Sign up</button>
</form>Text Content
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* Meet Gwen
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* Official Portrait
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* Sponsored Legislation
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* News
* Press Releases
* In the News
* Opinion Pieces
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* Newsletter Archive
* Contact Me
* Email Me
* Meeting or Event Request
* E-Newsletter Sign Up
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MEETING/EVENT REQUEST
Contact Information
Prefix *
First Name *
Last Name *
Suffix (Jr., Sr.)
* Street Address
* City
* State
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT
NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Zip
* Email
* Organization Name
* Contact Phone Number
About the Meeting
* Available Dates and Times
* Location:
DC Milwaukee * Names and Hometowns of Attendees
* Specifically, what topics do you wish to discuss?
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* Facebook
* Twitter
* Instagram
* Youtube
OFFICE LOCATIONS
* Washington, DC Office
2252 Rayburn HOB
Washington, DC 20515
Phone: (202) 225-4572
* District Office
250 East Wisconsin
Suite 950
Milwaukee, Wisconsin 53202
Phone: (414) 297-1140
Fax: (414) 297-1086
* Meet Gwen
* Biography
* Committee Assignments
* Official Portrait
* Services
* Updates to Public Charge Rule
* Veterans
* Flag Requests
* Local Agencies
* Congressional Commendation
* Event Request
* Congressional Art Competition
* Presidential Greeting Request
-->
* Tour Request
* Issues & Legislation
* Economy and Jobs
* Ending Hunger and Poverty
* Health Care
* Protecting the Environment and Restoring the Great Lakes
* Empowering Children to Succeed
* Working for Women
* Protecting Consumers and Wall Street Reform
* Caring for Veterans
* Immigration
* Voting Record
* Sponsored Legislation
* Co-sponsored Legislation
* News
* Press Releases
* In the News
* Opinion Pieces
* Events
* Newsletter Archive
* Contact Me
* Email Me
* Meeting or Event Request
* E-Newsletter Sign Up
* Office Locations
* Interactive Map
* Follow Me
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