Registration Form for Reclaiming Florida's Future
Please Note: Registration closes Weds. 3/4/19 at 11:59pm

We're looking forward to meeting you on 3/13/19, and joining forces in the fight to RECLAIM FLORIDA'S FUTURE FOR ALL! This short survey will let us know more about you, and where you will be able to contribute the most during "Reclaiming Florida's Future for All." Your input is important to us, and it is our hope that you will enjoy participating!

First Name: *
Your answer
Last Name: *
Your answer
Phone Number: *
Your answer
Email address: *
Your answer
Physical address *
We will not share your address with any third party. The purpose of this question is to verify your Florida Legislative representatives.
Your answer
Zip *
Your answer
City *
Your answer
County *
Your answer
Who is your representative at the State House? *
Your answer
Who is your State Senator? *
Hint: Not Marco Rubio or Bill Nelson. If you're unsure, you may check at:
Your answer
How will you be traveling to Tallahassee? *
We will be providing transportation from major population centers. Stay tuned for details and indicate your preference below
Where will you be staying March 12th? *
For a bed/ mattress at the Center, please include your payment at the end of this survey
Lunch will be provided on 3/13 for those who complete this form. Do you have special dietary needs? *
What times will you be attending on March 13th?
The event itself goes from 10am-4pm
Your answer
Will you contribute $20 to offset transportation and food costs? *
We want to make this accessible to everyone, but if you are able to offset transportation and food costs, please indicate below. If another amount, please indicate that in 'Other'
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