New York Counts 2020 Census Day of Action       Albany - March 5th  Registration    
We will leave early in the morning on Tuesday, March 5th and return in the early/mid evening on the same day.  Please complete form by Friday, December 21st.  We need a count of individuals committed to go so we can plan travel/food logistics.  Thank you!!
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Organization Name *
Organization Contact Person *
Organization Contact Person's Email Address *
Organization Contact Person's Phone Number *
What is the geographic coverage of your organization (what areas do you cover, i.e. Buffalo, Queens, Albany County, etc) *
Participant Name *
Participant's Phone Number *
Participant's Email Address *
What NYS Assembly district(s) does your organization serve? *
What NYS Senate district(s) does your organization serve? *
What is the participant's NYS Assembly district? *
What is the participant's NYS Senate district? *
Does Participant have any dietary restrictions? *
What is Participant t-shirt size? *
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