Participant Details

Thank you for your interest in attending IMPACT 2021 on Tuesday, October 12, 2021. 

Please complete this form and we will share more event details as they become available.

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* Please enter your contact information.

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* With which category do you identify?

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* Have you participated in prior IMPACT events? Please check all that apply.

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* Are you willing to complete follow-up activities after IMPACT 2021. Examples include writing thank you notes to the staff you spoke with during your virtual Congressional visits, etc.

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* I understand that this is a virtual event and I confirm that I have access to a computer with internet and telephone.

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