2018 Resident Advocacy Program Registration

This registration is for the May 21 & 22nd Residency Advocacy Program and Lobby Day.

Contact Information: (Please complete in full)

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* 1. Contact Information: (Please complete in full)

Resident #1 Contact Information....

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* 2. Resident #1 Contact Information....

What is your gender? (used for hotel purposes)

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* 3. What is your gender? (used for hotel purposes)

Resident #2 Contact Information...

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* 4. Resident #2 Contact Information...

What is your gender? (used for hotel purposes)

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* 5. What is your gender? (used for hotel purposes)

Hotel Accommodations Needed?
We will contact residents after receiving their registration regarding hotel stay.

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* 6. Hotel Accommodations Needed?
We will contact residents after receiving their registration regarding hotel stay.

Do you have any dietary restrictions?

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* 7. Do you have any dietary restrictions?

Thank you for applying to the Resident Advocacy Program. We will contact you shortly to finalize your application. Should you have questions or need additional information please contact Ericka Hancox at ehancox@ny.acog.org  or 518-436-3461, ext. 501.

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