2015 California Advocacy Summit
Sacramento, California
April 20 & 21, 2015

Registration for the California Advocacy Summit is now open!

The deadline to register is April 3, 2015. For more information or questions about the Summit, please contact Steven Schultz, Advocacy Coordinator at sschultz@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 Range: 12-18 years old
19-30 years old
31+ years
Please indicate what type of arthritis you have: Osteoarthritis
Rheumatoid
JA
Other
Disease Type:
If you have an existing relationship with a State Legislator, please provide their name:
Want to be in the same group as other attendees? List name(s) here. (additional registration required for each participant):
Will you need assistance with transportation from the hotel to the Capitol?: Yes
No

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:
Can we share your information with other Summit attendees?: 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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