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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 *
Your answer
First Name *
Your answer
Phone Number *
Your answer
City *
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
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?
Your answer
Transportation Accommodations
The Second Chance Alliance will be providing buses to select locations throughout the state of North Carolina to assist individuals interested in using these means to travel to and from the Lobby Day gathering site. There is no cost to ride these buses.
Are you interested in free transportation via bus from your location to and from the Lobby Day site?
Do you have any accessibility needs related to bus travel?
If you answered "Yes" to the question above, please take a moment to let us know how to best accommodate you.
Your answer
If you are interested in free transportation via bus, from what geographic area would you be coming?
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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
Age
Are you directly-impacted by the Criminal Justice system? (Are you currently incarcerated, formerly incarcerated, or on probation?)
A copy of your responses will be emailed to the address you provided.
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