Thank you for registering for the New York State Lobby Day at the Capitol on March 12, 2014. Please complete all of the following questions so that we can match you with your legislators. Registrations must be received by February 17, 2014

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* 1.

Please complete the following information. You MUST provide your home address so that we can schedule your visits with your elected officials. Cell phone numbers will only be used to reach you if needed. If you would like to skip a section, please type in that section "n/a."

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* 2.

Please list the name(s) of anyone that will be attending the event with you.

We will be providing a boxed lunch to registered attendees. Please list any dietary restrictions so that we can ensure we meet your needs.

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* 3.

Has heart disease or stroke impacted your life? Your written story may be included in packets on the day of the event and possibly used for media promotion of the event.

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* 4.

Do you personally know an elected official? If yes, please include the name(s) below.

Thank you for registering for the 2014 New York State Lobby Day! Please let us know if your schedule changes and you are unable to attend. We look forward to seeing you on May March 12th!

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