California Capitol Day Registration 2015

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 3:30 pm in Sacramento on Wednesday, May 13. Additional information, such as an agenda, materials and details about the training webinars, will be provided via email. For any questions, please contact Justin Garrett, State Director of Advocacy & Government Affairs, at jgarrett@marchofdimes.org or (916) 576-2836.

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* 1. 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)

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* 2. 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

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* 3. Do you have a personal connection to the March of Dimes mission? If yes, please briefly describe.

Yes

Please describe the connection

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* 4. 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.

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* 5. Please state any dietary restrictions:

Vegetarian

Gluten Free

Other (please specify)

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* 6. 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