Engage in the Campaign (Individual Registration)
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First Name *
Last Name *
E-mail Address *
State or U.S. Territory *
If you live outside of the U.S., please let us know where you are joining us from.
Skip this question if it is not applicable to you.
Zip Code *
What legislative district do you live or work in? *
Visit this website if you need help: https://www.house.gov/representatives/find-your-representative. Please respond using TWO digits (i.e., if you live in NY-26, you would fill in "26" below.
Can we display your name and congressional district on the National Trauma Campaign website for supporters in your district to contact you?
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I agree that you can share my name and email address with the volunteer Local Liaison who is working with the Campaign in my congressional district for the purposes of coordinating actions and opportunities related to the Campaign. I understand that I may choose whether or not I become involved in coordinated actions on a case-by-case basis. I further understand that I can contact the Campaign at traumacampaign@gmail.com at any time to rescind this agreement. *
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