March of Dimes California Capitol Day 2013 Registration

Please fill out the short survey to register for the March of Dimes California Capitol Day. The event takes place from 9:00 am to 3:00 pm at the State Capitol in Sacramento on Tuesday, May 21. Additional information, such as an agenda and details about the training calls, will be provided via email. For any questions, please contact Justin Garrett, State Director of Advocacy & Government Affairs, at jgarrett@marchofdimes.com or (916) 576-2836.

1. Please provide your name, registered voting address and contact information.

Please provide your name, registered voting address and contact information. First Name
Last Name
Voting Address
City
Zip Code
Phone Number
Email Address
Organization (or put individual)

2. How many times have you attended Capitol Day or similar events before?

How many times have you attended Capitol Day or similar events before? Never, this will be my first time!

1-2 times

3 or more times

3. Identify any specific legislators you want to meet with and/or have a connection with. Please provide an explanation, such as you are neighbors with Senator Jones or you used to work with a staff member for Assembly Member Smith. Note - these meetings are special requests and we cannot guarantee that you will meet with the identified legislators.

Identify any specific legislators you want to meet with and/or have a connection with. Please provide an explanation, such as you are neighbors with Senator Jones or you used to work with a staff member for Assembly Member Smith. Note - these meetings are special requests and we cannot guarantee that you will meet with the identified legislators.

4. Your email will be added to the March of Dimes advocacy list to receive periodic action alerts, such as requests to email your legislators to vote yes on our priority bills. If you do not want your email added to the list, please check the below circle.

Your email will be added to the March of Dimes advocacy list to receive periodic action alerts, such as requests to email your legislators to vote yes on our priority bills. If you do not want your email added to the list, please check the below circle. Please do not add my email to the March of Dimes advocacy list