Advocate Sign-up Form

Thank you for adding your name to the ever-growing list of advocates ensuring that Consumer Directed Personal Assistance (CDPA) continues to grow & stay strong in New York State.

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* 1. First Name

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* 2. Last Name

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* 3. Street Address

Example: 123 Main Street

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* 4. City

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* 5. State

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* 6. ZIP Code

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* 7. Email Address

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* 8. Phone Number

Example: 718-555-1234

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* 9. What skills or talents do you have or are willing to learn?

I can create and share social media posts

I can write op-eds or letters to the editor

Storytelling: speaking and telling your story (on camera) to elected officials, reporters, etc.

I am willing to conduct local (district) office visits in your community

I am willing to travel to Albany and other locations for actions and office visits

I have personal or professional connections that can help the movement.

I can offer transportation assistance to consumers who do not have transportation.

I am not sure, but I'd like to learn more.

Advocate Sign-up Form

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Street Address Example: 123 Main Street

Question Title

* 4. City

Question Title

* 5. State

Question Title

* 6. ZIP Code

Question Title

* 7. Email Address

Question Title

* 8. Phone Number Example: 718-555-1234

Question Title

* 9. What skills or talents do you have or are willing to learn?

* 3. Street Address

Example: 123 Main Street

* 8. Phone Number

Example: 718-555-1234