Registration for CHAPA Housing Day - March 11, 2019
Please join CHAPA for our Housing Day at the State House on Monday, March 11, 2019. This is an important opportunity for housing advocates to come together to meet with legislators to help promote and support the policies and resources that will help every family in Massachusetts have a safe, healthy, and affordable place to call home!
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Organization/Business Affiliation
Please let us know if you are affiliated with an organization or business.
Your answer
Meeting with Legislators *
Please select how you would like to participate during Housing Day! Meeting with your legislators is an effective way to help make affordable housing a priority at the State House and to advocate for related issues. If you are willing to meet with legislators, please check if you will set up your own meeting or if you want CHAPA's assistance to set up a meeting.
Required
State Legislator Information
If you will be meeting with legislators, please provide the names of your state legislators. This information will help CHAPA arrange meetings and engage with lawmakers. To find your state legislators, visit: https://malegislature.gov/Search/FindMyLegislator
Name of State Representative
Your answer
Name of State Senator
Your answer
Address Information
Please enter your address information if you would like CHAPA's help in setting up meetings with your state legislators who represent the communities that you live or work in.
Street Address (Home)
Your answer
City (Home)
Your answer
ZIP Code (Home)
Your answer
Street Address (WORK)
Your answer
City (Work)
Your answer
ZIP Code (Work)
Your answer
Dietary Restrictions
Please let us know if you have any dietary restrictions. Morning refreshments will be provided. Lunch will be available for those staying after the speaking agenda to meet with legislators.
Your answer
Event Accommodations
Please let us know if you will need any type of accommodation at the event (e.g. ASL interpreter, captioning, assisted listening devices, etc). CHAPA is committed to providing access, equal opportunity, and reasonable accommodation in its services, programs, and activities. To request or discuss any accommodation, contact Eric Shupin at (617) 682-9712 or eshupin@chapa.org.
Your answer
Photography & Video Release
Citizens’ Housing and Planning Association (CHAPA) reserves the right to use any photograph/video taken at any event sponsored by CHAPA without the expressed written permission of those included within the photograph/video. CHAPA may use the photograph/video in publications or other media material produced, used, or contracted by CHAPA. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed/videotaped subject, parent, or legal guardian. A person attending a CHAPA event who does not wish to have their image recorded for distribution should make their wishes known to the photographer/videographer, and/or the event organizers, and/or contact CHAPA directly.

If you have any questions about the event or this form, please contact Eric Shupin at eshupin@chapa.org or (617) 682-9712.

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