Day at the AZ State Legislature

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* 1. Registration is FREE but it is required to ensure adequate materials and meals. it is very important that we have your name, contact information and home address (to confirm you legislative representatives.) Please provide that information below.

Name

Address

Address 2

City/Town

State

Zip

Email address

Phone Number

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* 2. We want to know the organizations to which you belong. If you have more than one organization, could you please list in the box below?

ACP

ArMA

AOMA

MCMA

PCMS

Specialty Society

Other (please specify)

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* 3. We will make every effort to schedule your appointment with your elected representative in the early afternoon, but will have to work individually with the sometimes complicated schedules of the representatives.

I will be there all day.

I prefer a morning appointment

I prefer an afternoon appointment

I will not be able to meet with a legislator, but will be in attendance.