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ANS > Public Information > Nuclear Professionals > Member Outreach > Communication Toolkit > Report Your Efforts
ANS has created this simple form for nuclear advocates and ANS members to record contact information of elected officials, journalists, teachers, or students with whom they discuss the benefits and value of nuclear science and technology.

Your Name:
 Address:


City:
 State:
 Zip Code:



Telephone:
 E-mail Address:


ANS Member (National):
 Local Section Member:
Yes       No
 Yes       No

Name of Contact You Made:
 Title:


Date:
,

Please indicate the topics you discussed during your meeting:
1:
2:
3:
Other:

What was your overall impression of the individual's or organization's attitudes about nuclear science and technology?
Negative
 Undecided
 Positive

Next Step:    (please check all that apply)
I will send more materials.

I will call with specific resources.

I will meet again.

I will alert contact to other issues when they arise.

Please describe any special activities that you have attended, participated in, or organized where nuclear policy issues were addressed:


Please Note:  You will have the option to submit comments and additional information after submitting this form.


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