Birth Justice Days at the Capitol Registration Form
This is the registration form for those traveling to Tallahassee, Florida for Birth Justice Days at the Capitol.
TBA
Thank you for completing as soon as possible. Spaces are limited and will be on a first come first serve bases.
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Email *
Last Name *
First Name *
Pronouns *
Organization *
Residential Address *
Phone Number (including Area Code) *
Do we have your permission to text you? *
Location (City/County/Zip Code) *
Will you be traveling with minors (18 years or under)? *
If Yes, please share their ages. *
Will you need transportation to Tallahassee? *
Will you need lodging in Tallahassee? *
Are you willing to drive to Tallahassee?  *
Are you willing to transport others to Tallahassee? *
If Yes, How many seats will be available? *
Emergency Contact (Name) *
Emergency Contact (Phone number) *
Dietary Restrictions *
Pickup and Drop off *
Social Media Handles and/or Website link *
How did you hear about SBJN? *
I am a... (Select all that apply)
 *
Required
If other to above question (please specify) *
Do you have experience speaking with legislators? *
Do you feel comfortable talking to folks about birth justice? *
What are you hoping to gain from this experience?
Check all the boxes below to ensure you are willing to honor our values / agreements: *
Required
If you have any comments questions or concerns, please leave them here  *
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