Thursday, April 12, 8:30 - 4:00
Madison Concourse Hotel 

Family Voices hosts Advocacy for Change, a leadership institute, for parents and family members to learn advocacy skills and strategies. Participants will learn about policy and legislative issues that affect Wisconsin families who have children with disabilities and special health care needs. The day includes visits with senators, representatives and staff at the State Capitol.

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* 1. I am a:

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* 2. Contact Information

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* 3. The best way to communicate with me is:

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* 4. Organizational affiliation (if any)

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* 5. Parents/Families: Please list the age(s) of your child(ren) with disabilities or special health care needs.

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* 6. What disabilities or conditions are of interest to you?

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* 7. What would you like to learn at this leadership event?

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* 8. What topic/issue would you like to talk about with your Legislators?

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* 9. Have you ever participated in (please check all that apply):

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* 10. How did you hear about this event?

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* 11. After this event, will you be able to work with Family Voices to inform families in your community about advocacy and policy issues?

The following questions will help us understand your experience and background. Your answers will not impact your application in any way!

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* 12. I believe that by being involved I can make a difference.

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* 13. I know how to tell my family story to educate elected officials.

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* 14. I know who represents me at the State Capitol and how to contact my elected representatives.

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* 15. Will you need any special accommodations, like a wheelchair ramp or a translator, to participate in this event?

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* 16. If you live outside of Madison, will you need additional financial support for travel expenses?*

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* 17. Registration Fees: Please choose the option that reflects what you are able to pay.

There are tons of Wufoo features to help make your forms awesome.
 Family Voices staff will contact you to confirm your participation and discuss travel stipend.
If you have any questions, contact Lynn at 608-828-9959 or lynn@fvofwi.org.


To learn more about Family Voices go to FamilyVoicesofWisconsin.com

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