Information and Waiver Form
October 2, 2018 - (Lobby Day) DE says NO to Kavanaugh - Washington, DC

NOTE: All attendees are responsible for returning to the van on time for departure back to Delaware.

Name *
Cell Number *
Emergency Contact Name and Relationship *
Emergency Contact Cell/Phone Number *
Emergency Contact Address *
What target states are you affiliated with? (Do you have friends or family living in one of these states that you can speak on behalf of?) CHECK ALL THAT APPLY
Pick up location and time *
Image/Media Release
Personal Conduct Agreement *
Liability Waiver *
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