Statewide Week of Advocacy Meeting Reporting Form

Demographic Information

Thank you for taking part in the week-long statewide advocacy campaign! Your in-district meetings with legislators and their staff build critical relationships and demonstrate to our elected officials why domestic violence prevention and intervention services are vital to the health and safety of your community

Question Title

* 1. Please provide your contact information.

Name: *

Organization: *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address: *

Phone Number:

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* 2. Your region:

Far North

North

Bay Area

Central Valley

Central Coast

Los Angeles

South

Unsure