SAGE 2020 National Day of Advocacy Registration

First name

Last name

Would you like your name to appear differently on your name tag?

Name tag

Email address

Cellphone (if you don't have one, put N/A)

Pronouns

Other

Home street address

City

State

Zip code

Are you affiliated with any of the following?

Please list affiliation.

Do you have any dietary restrictions?

Have you lobbied before?

Do you have a relationship with any members of Congress?

Congress member's name

How do you know them?

Do you use a wheelchair, scooter, or other mobility-assistive device?

I would like to have an able-bodied volunteer assist me

I am an able-bodied person and willing to volunteer to help others

I am an experienced advocate and able to assist others during meetings

Please keep in mind there is a lot of walking during the National Day of Advocacy. All venues are ADA accessible, but we want to know if there are any additional accommodations we can provide that will increase your comfort or ability to learn and network? If not applicable, please indicate n/a.

Are you willing to share your story about experiencing the following? (Check all that apply)

Other experience