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Retail Action Network Sign-up Form

Contact Information:

First Name:

Last Name:

Business/Company:

Title:

Address:

City:

State/Province:

Country: (if not US)

Postal Code/Zip:

Phone:

Fax: (Please provide if possible)

Email:

Please list issues of particular interest/concern to you:

Becoming involved with NRF:

Please send me additional information on how to become involved with NRF's Political Action Committee

Please send me additional information on how to become a member of NRF

Please indicate who your legislators are: (optional)

U.S. Representative/Senator	You know this legislator through	How well do you know this legislator?
1.	Business Activities Personal Connections Other	Very Well Well Not at all
2.	Business Activities Personal Connections Other	Very Well Well Not at all
3.	Business Activities Personal Connections Other	Very Well Well Not at all

If you have any questions or comments, please contact Marsha Dionne at
(202) 626-8152 or via email at dionnem@nrf.com.