Suffolk County Legislature Form Center

2. First Name
3. Last Name
5. How would you like to be addressed?
7. Email Address
8. Confirm Email Address
10. Address
12. City
13. State
14. Zip Code
16. In what format would you like to receive your newsletter:

    1. Please send my newsletter via email (fill in your email address above).
    2. Please send my hard copy newsletter via regular mail (fill in your name and full mailing address above).
18. Name of My Legislator
    -- Select One --Al Krupski - 1st DistrictBridget Fleming - 2nd DistrictJim Mazzarella - 3rd DistrictNick Caracappa - 4th DistrictVacant - 5th DistrictSarah S. Anker - 6th DistrictDominick Thorne - 7th DistrictAnthony A. Piccirillo - 8th DistrictSamuel Gonzalez - 9th DistrictTrish Bergin - 10th DistrictSteven J. Flotteron - 11th DistrictLeslie Kennedy - 12th DistrictRobert Trotta - 13th DistrictKevin J. McCaffrey - 14th DistrictJason Richberg - 15th DistrictManuel Esteban Sr. - 16th DistrictTom Donnelly - 17th DistrictStephanie Bontempi - 18th DistrictClerk of the LegislaturePresiding Officer of the Legislature

    Pick your Legislator

20. Who is my Legislator?
    Suffolk County Voter Information
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field