New Resident Survey All new residents age 18 and older are encouraged to fill out my New Resident Survey, which will help me better serve you. With the information you provide, I will be able to send you relevant information that is specific to your life, including any legislative changes that may affect professional licenses you hold and outreach events that may benefit you. Of course, this information will not be sold or used for other purposes. First Name * Last Name * Address1 * Address2 * City * State * PA AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code(5-Digit) * Email Address * Leaving this box checked verifies that you would like to receive email updates from this state representative Date of Birth (MM/DD/YYYY) * 1. Are you a new Pennsylvania resident? * Yes No 2. Are you a new Montgomery County resident? * YesNo 3. Are you a veteran? * YesNo 4. What branch of the military did you serve? * Air Force ArmyMarine Corps Coast Guard NavyNot applicable 5. During which conflict era did you serve? * 6. Do you hold any Pennsylvania-issued professional licenses for your job? * YesNo 7. What professional license do you hold? 8. Would you like to receive any state forms and/or applications? * YesNo 9. What state forms and/or applications would you like me to send you? 10. Home Phone Number 11. Cell Number Submit