2022 Rally for Medical Research Participant Sign-Up

General Information

Registration Deadline: September 2, 2022

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1. Please enter your full name

First Name

Last Name

Suffix (MD, PhD, Jr., Sr., etc.)

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2. Business Name / Organization (if applicable)

Title/Role (if applicable)

Affiliated Organization

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3. Please provide your home address.

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

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4. Please provide a contact number in order to reach you while in Washington, DC with any day-of-the-Rally changes.

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5. Email Address

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6. Please provide your business address.

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Phone Number *

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7. Have you participated in a Hill Day before?

Yes

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8. What events will you participate in during the 2022 Rally for Medical Research?

Rally for Medical Research Training (1:30 pm - 3:30 pm Tuesday, September 13) Park Hyatt Hotel

Reception to Celebrate Medical Research (5:00 pm - 7:00 pm Tuesday, September 13) Rayburn Cafeteria, Rayburn House Office Building

Rally for Medical Research Breakfast (7:00 am - 9:00 am Wednesday, September 14) Park Hyatt Hotel

*Please note that attendance at both the Rally for Medical Research Training and Breakfast is highly recommended, especially for first-time Rally participants.

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9. Do you have any special relationships with House or Senate offices?

If yes, list office(s).