Lobby Day May 19, 2017 - Bus Transportation Sign Up Sheet

This registration form works best in Google Chrome, Firefox, or Safari. It will not work properly in Internet Explorer. Click on the line under the question to start typing. If you need help please email Events & Travel at events@calnurses.org or call at 510-433-2765.

Email address
First Name:
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Last Name:
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Cell Phone
e.g. (987) 654-3210
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Organization:
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State Assembly Member (if known):
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State Senator (if known):
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Please list any food allergies / restrictions or special needs accessibilty requests:
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