Get Youth Moving: Day at the Capitol Registration Question Title Please join us Thursday, April 16, 2015 in Madison to show support for the GYM Act to Get Youth Moving. To attend, please fill out the registration form below. Let's get started! Question Title * 1. Please enter your information and HOME address below. Full Name: Email Address: Street: City: State: Zip: Phone Number: Question Title * 2. If you are representing an organization other than the American Heart Association, please indicate which organization: Question Title * 3. Do you have any special needs? Food or accessibility? No special needs I will need wheelchair assistance Vegetarian Vegan Gluten-Free Other (including food allergies) Question Title * 4. If you have other special needs, please note and email jason.harder@heart.org after you complete your registration. Question Title * 5. We will provide unisex T-shirts for the day. Please let us know what size you would like! Small Medium Large X-Large 2X-Large 3X-Large Next