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2019 Second Chance Alliance Lobby Day Sign- Up
Please use the following form to let us know that you'll be joining the 2nd Chance Alliance for its 2019 Lobby Day activities in Raleigh, NC on May 7th, 2019.
Email address *
Last Name *
First Name *
Phone Number *
City *
Emergency Contact Name
Emergency Contact Phone Number
Language Supports
A majority of Lobby Day programming will use spoken English as its primary form of communication, but we strive to make our activities as inclusive and accessible as possible. Though we cannot provide translations for all languages, we do want to be aware of language needs so that we can accommodate as much as possible this year and make strides in the future to continue to remove this barrier.
A majority of Lobby Day programming will use spoken English as the primary form of communication. Is there a language translation that you need in order to participate in our activities? If so, what language supports do you need?
Do you have any accessibility needs that the coalition should plan for?
Clear selection
If you answered "Yes" to the question above, please take a moment to let us know how to best accommodate you.
From which geographic area would you be coming?
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T-Shirt Size
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Demographic Information
This information is used SOLELY to collect data to tell us what communities are represented at this event.
Gender Identity
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Age
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Are you directly-impacted by the Criminal Justice system? (Are you currently incarcerated, formerly incarcerated, or on probation?)
Clear selection
A copy of your responses will be emailed to the address you provided.
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