2022 Catalyst to the Capitol Partner Application
Join our 2022 Catalyst to the Capitol trip as an organizational partner!

Catalyst Miami is accepting applications for our annual Catalyst to the Capital (C2C) trip to Tallahassee. Being a C2C Partner provides an opportunity to advocate on behalf of yourself, your family, and your community. This experience also provides space to interact with government officials in Miami and Tallahassee, joining a network of activists and committed community leaders with shared interest in improving the well-being of Miami-Dade residents.

The 3-day trip includes: travel to and from Tallahassee, hotel, and meals. Partners will also have access to in-person meetings and social events with elected officials, group activities, and an opportunity to sharpen your advocacy skills. Training and support will be provided before and during the trip. Partners' logos will also be added to our materials (optional).

The trip dates are TBD, but will take place during a 3-day period (Tuesday-Thursday) in February. Partners are asked to pay $500 per seat to attend Dade Days in Tallahassee with Catalyst Miami. Seats will be reserved on a first-come, first-served basis.
Name *
Email *
Organization Name *
Street Address
City
Zip Code
Phone Number *
Proof of Covid-19 vaccination will be required for participation in this trip, particularly because we will likely be traveling by plane. Will you be able to complete your vaccination, as well as provide a copy of your vaccination card to us by December 2021? *
What policy issues is your organization interested in (i.e. healthcare, Medicaid expansion, education, minimum change, criminal justice reform, climate change, environmental, etc.)? *
Are you supporting/opposing any bills during this session? If so, which? *
Have you participated in policy advocacy and/or direct actions in the past?(i.e. town halls meetings, canvassing, rally, marches, calls to legislators, letters to legislators, etc.) *
Do you have connections with policymakers that we can meet with during Dade-days? If so, who? *
Please use the area below to describe any specific accommodations that you will require in order to take part in this trip. Be advised that this is a physically demanding trip, which includes extended periods of moving/standing and the use of steps in order to enter or exit the charter bus used for transportation.
Do you have any allergies and medical conditions we should know about? (i.e. allergies: food, insects, medicine; medical conditions: diabetes, asthma, etc.)
Emergency Contact Information
Primary Emergency Contact Name:
Relationship to Contact:
Daytime Phone / Evening Phone:
Email Address:
Secondary Emergency Contact Name:
Relationship to Contact:
Daytime Phone/ Evening Phone:
Email Address:
I give my permission for this information to be shared with program funders for monitoring and evaluation and funding purposes. (Sign below) *
I hereby authorize and give consent to Catalyst Miami and program funders to take/use still photographs, digital photographs, motion pictures, television transmission, and/or videotaped recordings of me for educational, research, documentary, marketing, and public relations purposes. (Sign Below) *
In consideration for being allowed to participate in this Activity, I release from liability and waive my right to sue the Catalyst Miami, Inc., their employees, officers, volunteers and agents from any and all claims, including claims of their negligence, resulting in any physical injury, illness (including death) or economic loss I may suffer or which may result from my participation in this Activity, travel to and from the Activity or any events incidental to this Activity. (Sign below) *
Signature: *
Today's Date: *
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