Email Form

Rep. Tom Dippel District 41B

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Please use the following form to reach Representative Dippel's Legislative Assistant, Kyle Baker with your comments and concerns.

Your Representative would like to hear particularly from constituents so please include your full name and address.

NOTE:
All fields marked with an asterisk (*) are required and must be completed.

First Name *

Last Name *

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Phone

Street Address 1 *

Street Address 2

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Subject *

Message to Representative Dippel