NYS Hep C Legislative Awareness Day 2010
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1. Are you interested in attending the New York State Hepatitis C Legislative Awareness day on March 3, 2010 in Albany, New York?

Are you interested in attending the New York State Hepatitis C Legislative Awareness day on March 3, 2010 in Albany, New York? Yes

2. We will be providing free bus service from Manhattan. If you plan to attend do you need transportation?

We will be providing free bus service from Manhattan. If you plan to attend do you need transportation? Yes, I am interested in transportation

No, I will provide my own transportation

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3. Please type your name and contact information in the box below. We will need your complete home or business address, email address if applicable and a phone number. If you do not have a permanent address or access to a computer, please call us toll free at
866-466-5086. (Please note: this information IS strictly confidential).

Please type your name and contact information in the box below. We will need your complete home or business address, email address if applicable and a phone number. If you do not have a permanent address or access to a computer, please call us toll free at 866-466-5086. (Please note: this information IS strictly confidential).

4. If you have any further questions or would like more information, please enter your questions in the box below, or email us at sfoster.statuscunknown@gmail.com

If you have any further questions or would like more information, please enter your questions in the box below, or email us at sfoster.statuscunknown@gmail.com

5. Would you be interested in attending a group advocacy training in Manhattan prior to the trip to Albany? Please note this is an optional training and participation is not required to participate in HCV Legislative Awareness Day.

Would you be interested in attending a group advocacy training in Manhattan prior to the trip to Albany? Please note this is an optional training and participation is not required to participate in HCV Legislative Awareness Day. Yes, I would be interested in attending an advocacy training

No, I would not be interested in attending an advocacy training

6. How would you like us to contact you? Please make sure all contact information is listed in your reply to question 3.

How would you like us to contact you? Please make sure all contact information is listed in your reply to question 3. Phone

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