Constituent Meeting Request

Please fill out the following form to be considered for a constituent meeting or phone call with Governor LePage. A staff member will follow up with you as soon as possible; however, we ask for your patience as we process the large volume of requests that we have received.

Before making your request, please consider:

• Meetings and/or phone calls occur most Saturday mornings between the hours of 9:00am-11:00am.
• You will be assigned a 10 or 15-minute time slot. Due to the tight constraints on the Governor's schedule, you will be asked to adhere tightly to your allotted time.
• Interest in these meetings is high and there is often a waiting list. For this reason, it is possible that a Department Commissioner or other Governor's office staff member may be asked to assist you, depending on the nature of your request.

First Name (as it appears on your driver license)
Last Name (as it appears on your driver license)
Date of Birth: (mm/dd/yyyy)
Email:
Daytime Phone:
Street Address:
City:
State:
Zip:
Purpose of meeting/brief synopsis of agenda (please be specific):
List any State agencies you have previously worked with on this issue:
List the dates of any Saturday that you could NOT attend:

Due to the nature of the Governor's duties to the State of Maine and its citizens, the Governor may need to cancel and/or postpone meetings in order to attend to pressing state matters. Although we will make every attempt to notify you of a cancellation in a timely manner, please understand that may not always be possible.