2014 Albany Medical Student Advocacy Day

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Please join us in Albany, NY to advocate on health justice issues, including a single-payer health care system in New York State! Complete this form so that we can organize meetings with your legislators and transportation for those who plan to attend.

Date: Jan 28, 2014
Time: 8am to 4pm (appointment times vary, but everybody should be present for the lunch time press conference/rally at 12:30pm)
Location: New York State Capitol, Albany, NY; lunch time rally: LCA Press Room in the Legislative Office Building

Last Name, First Name *

Email Address *

Street Address *

City *

Zip *

Cell Phone Number *

School and School Year *

Transportation Needs/Offers *

I'd like to leave with the group from Albany Medical College

I'd like a seat in a van or car leaving from NYC

I'd like a seat in a van or car leaving from another part of the state

I'll be driving and can take others in my car

What is your preferred time slot to meet with your legislator(s)?

10:30-12p

1:15-3pm

3-4 pm

Clear selection

Can you help with recruiting participants for Advocacy Day?

Yes

Will this be your first time lobbying?

Yes

Will you be present at the 12:30 pm press conference and rally that day?

Yes

If you know, who are your state legislators?

Which group (s) will you be joining? *

PNHP/SNaHP - single payer

PHR

NYSPHA

Required

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