2014 California Advocacy Summit
Sacramento, California
April 22 & 23, 2014

Registration for the California Advocacy Summit is now open!

The deadline to register is April 4, 2014. For more information or questions about the Summit, please contact Krystin Herr, Director of Advocacy at kherr@arthritis.org

Please enter your home address below as that information will be used to find your local representatives. Thank you!

Please read the Consent and Release Form before starting the application, as you will be asked for approval before submitting your registration. 

* required information
Registration 
Registration Information
First Name:*
Middle Initial:
Last Name:*
Name as you would like it to appear on your badge:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Cell Phone:*
Alternate Phone:
Email:*
Age: years old
Please indicate what type of arthritis you have: Osteoarthritis
Rheumatoid
JA
Other
Disease Type:
Have you attended the CAFC Advocacy Day in the past? If yes, when?:*
IF you have an existing relationship with a State Senator or State Assembly member please provide their name:
Want to be in the same group as other attendees? List name(s) here. (additional registration required for each participant):

Payment Information


$75.00 Registration Fee
(Fee is per person.)

Promo Code


If you have received a promo code, please enter it here:

Other Information

Do you have any food allergies? If yes, please list them:
Embassy Suites is about 1 mile away from the Capitol. Will you need assistance with transportation to and from the Capitol?:* Yes
No
I have read the terms and conditions of the emailed Consent & Release Form:* I Agree
I Decline

Please read the Consent and Release Form before submitting your registration.



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