NPCA Capitol Hill Day of Advocacy                  Thursday, March 7, 2024                                     Registration Form
During NPCA's National Days of Advocacy, please join us in Washington, DC for our Capitol Hill Day of Advocacy on Thursday, March 7, 2024. Please be aware of the following:
  • Please respect our registration deadline to give us sufficient time to plan for your visit: REGISTRATION WILL CLOSE ON TUESDAY, FEBRUARY 27, 2024.
  • Please register as soon as you have high certainty you can be with us on March 7th.  Our Hill Day planning software company charges us a fee for each registrant, including those who drop out at the last minute. And, registrants who end up not attending (or seeking to register at the last minute) can seriously impact our meeting scheduling.
More information on venues, exact times, and logistics will be sent in the coming weeks to the email address you provide below. Our Capitol Hill advocacy day starts early in the morning and lasts all day, with an end-of-day celebration. Please plan your trip to the nation's capital accordingly.

Questions or concerns? Email Jonathan Pearson at jonathan@peacecorpsconnect.org with the subject "Capitol Hill Day of Advocacy."  Thank you!
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First Name: *
Last Name: *
Cell Phone: *
Please list the phone number—with area code—you will have on hand on March 7.
Email (so we can send you information and updates) *
Registered Voting Address
Please provide the address where you are registered to vote
Street: *
City: *
State Code: *
ex: VA, CA, NY
Zip Code *
Secondary Address (if applicable)
We may place you in a group based on a previous address. For example, you may have a second residence, or lived for many years up until recently in another location. Please list any address that you had for several years prior to your current address.
My second address is:
(please select one)
If you answered "other" to the previous question, please explain.
Please check the following that best describes you: *
(you may choose more than one)
Required
If you chose other, please explain.
For our Capitol Hill Advocacy Day, no previous experience is necessary. However, to help with our planning please share with us your previous Capitol Hill experience. 
Clear selection
Please share if you have previous Capitol Hill Advocacy experience with any other organizations.
Peace Corps country and years of service:
Include up to 3 tours, using the following format: Kenya 1989-1991; Colombia 1994-1996
Please indicate which of the following best describes your physical capabilities *
If you answered "other" to the previous question, please explain
Would you be willing to be considered as a Group Leader? Group Leaders are required to attend pre-event virtual briefings, arrive early to greet your group, lead meetings, carry folders for each office visit, and have a fun day! Group Leaders must attend the entire day.
Clear selection
Will you plan to join us for a celebratory event (location TBD) at the end of our day on Capitol Hill (Approximately 5:30 PM - 7:30 PM)? *
Finally, as we are expecting to take numerous photo images and some video during our Hill Day,  we ask you to agree to the following photo/video release agreement: 
Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to National Peace Corps Association, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising, online/digital media, or other media activities. This consent includes, but is not limited to:
(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;
(b) Permission to use my name; and
(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings.
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