The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Afterschool & Summer Day at the Capitol 2017 Participation Form
Let us know if you are interested in participating in this years Day at the Capitol. We will have opportunities for you to join us as a Table Host, Student Performance or Legislative Visit. Please fill out the information below and we will be in contact to make further arrangements. Thank you for joining us as advocates for afterschool, summer and the youth and families that rely on them!
Name
Your answer
What organization or program do you work with?
Your answer
Email
Your answer
Phone Number
Your answer
Home or Work Address
To help us know which legislators you match up with. Must include street, city, and zip.
Your answer
How would you like to participate during the day?
Appointments
Would you like to meet with your representative, senator, or both?
What are the most convenient appointment times for you? We will attempt to schedule you during these times, however we will have to work with Legislators schedules. (You may select more than one time)
What would you like to speak to your legislator about? (You may select more than one)
Submit
Never submit passwords through Google Forms.
This form was created inside of OregonASK. Report Abuse - Terms of Service - Additional Terms