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Personal Information
* Create a Login Name:
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* First Name:
Middle/Initial:
* Last Name:
* Gender:
* Birth Date: / /
* Race/Ethnicity American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
I do not wish to self-identify.
* Home Address:
* City:
* State:
Province (Foreign)
* Zip Code: -
* Home Phone:
Fax:
* Email (Business):
Email 2 (Home):
5K Yes
No
Personal Interests/Hobbies
Countries visited
Spouse
Would you like FMC to CC your assistant on email communications? Yes
No
Assistant First Name
Assistant Last Name
Assistant Phone
Assistant Email
Local Yes
No
Are you currently a registered lobbyist? Yes
No
Which chamber(s) did you serve in?
(select all that apply)
House of Representatives
Senate
Party Affiliation:
(Select all that apply)
Democrat
Republican
Independent
State/Territory Represented
In which Congress did you first serve?
Year Entered - House1
What was your last year in the House of Representatives?
(If you served non-consecutive periods in office,
please enter the final year of your first period in office.)
If you served non-sequential periods in the House of Representatives,
in what year did you return?
If you served non-sequential periods in House of Representatives,
in what year did you leave again?
What was your first year in the Senate?
(Leave blank if you did not serve in the Senate.)
What year did you leave the Senate?
Committees served on:
(Please check all that apply)
House Agriculture
House Appropriations
House Armed Services
House Budget
House Education and the Workforce
House Energy and Commerce
House Ethics
House Financial Services (Banking)
House Foreign Affairs
House Administration
House Homeland Security
House Judiciary
House Natural Resources
House Oversight and Government Reform
House Rules
House Science, Space, and Technology
House Small Business
House Transportation and Infrastructure
House Veterans' Affairs
House Ways and Means
House Permanent Select Intelligence
Senate Agriculture, Nutrition, and Forestry
Senate Appropriations
Senate Armed Services
Senate Banking, Housing, and Urban Affairs
Senate Budget
Senate Commerce, Science, and Transportation
Senate Energy and Natural Resources
Senate Environment and Public Works
Senate Finance
Senate Foreign Relations
Senate Health, Education, Labor, and Pensions
Senate Homeland Security and Governmental Affairs
Senate Judiciary
Senate Rules and Administration
Senate Small Business and Entrepreneurship
Senate Veterans' Affairs
Senate Indian Affairs
Senate Select Committee on Aging
Senate Select Committee on Ethics
Senate Select Committee on Intelligence
Joint Economic Committee
Joint Committee on Printing
Joint Committee on Taxation
Joint Committee on the Library
Did you serve in a leadership office?
(Please select all that apply.)
Speaker of the House
House Majority Leader
House Minority Leader
House Majority Whip
House Minority Whip
Senate President pro tempore
Senate Majority Leader
Senate Minoirity Leader
Senate Majority Whip
Senate Majority Whip
Other (please specify in next field)
Other elected/appointed positions Attorney General
Secretary of Agriculture
Secretary of Commerce
Secretary of Defense
Secretary of Education
Secretary of Energy
Secretary of Health and Human Services
Secretary of Homeland Security
Secretary of Housing and Urban Development
Secretary of Labor
Secretary of State
Secretary of the Interior
Secretary of the Treasury
Secretary of Transportation
Secretary of Veterans Affairs
Governor
Lt. Governor
State Senator/Representative
Mayor
City Council
Other (please specify in next field)
Other offices
Current or former Ambassador Yes
No
AmbassadorPost
Languages Arabic
Cantonese
French
German
Italian
Japanese
Mandarin
Russian
Spanish
Turkish
Other (please specify in next field)
Other languages
Colleges/Universities attended1
Colleges/Universities attended2
Colleges/Universities attended3
If you served in the U.S. Armed Forces, which branch did you serve in?
Additional information from your military career:
Domestic Issues Bipartisanship
Campaigns/Campaign Finance Reform
Civil Rights/Race relations/Discrimination
Cyber-security/Information Technology
Deficit Issues
Economic Issues/ Trade Issues
Education
Energy
Environment/ Climate Change
Healthcare
Immigration/Integration
National Defense/Military
Social Issues
Social Security/Medicare/Welfare
Fight against Terror
Other (please list in next field)
Other Domestic
International Issues Environment/ Energy
Global economy and Trade
Global security
Human rights
NATO
Nuclear proliferation/Arms control
World Bank/IMF/Foreign Aid/ International Development
War on Terror
Germany
Japan
Turkey
Europe
China
Australia and Pacific Islands
East and Southeast Asia
Indian Subcontinent
Middle East and North Africa
South America and Latin America
Sub-Saharan Africa
Russia/former Soviet Satellite Republics
Other (please list in next field)
Other International
Boards
Interested in International Travel Australia and Pacific Islands
East and Southeast Asia
Europe
Indian Subcontinent
Middle East and North Africa
Russia and Former Soviet Satellite Republics
South America and Latin America
Sub-Saharan Africa
Interested in Congress to Campus Yes
No
Golf Yes
No

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