Thank you for your interest in the March 15 Fail First Coalition Advocacy Day in Des Moines, IA! Please complete the following survey by Friday, March 3rd. Additional information will be emailed to all registered participants.  If you have any questions, please email Michele Guadalupe at

* 1. I plan on attending the following activities on Wednesday, March 15

* 2. I am:

* 3. Please list your home address so that we are able to identify your legislators for visits. We will also need your cell phone number. 

* 4. There are a limited number of exhibit spots available in the Rotunda - please indicate if you would like to exhibit and which patient/provider organization you are representing.  Exhibit hours are from 12:30pm - 4pm in the State Capitol.  A confirmation email with additional information will be sent.

* 5. Please let us know your story and why you would like to attend this year's IA Fail First Coalition Advocacy Day! Do you have trouble accessing your medications? Do you have an existing relationship with any of our state legislators in Iowa?

* 6. Please use this space if you have any questions or comments for us. Thank you!

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