New York Health Act Weekly #HealthcareHero Action Registration
Please submit this form to let us know when you will be visiting your local legislative office. An organizer with the Campaign for NY Health will check in with you about materials and to offer support.
Your First Name *
Your answer
Your Last Name *
Your answer
Your Email *
Your answer
Your phone number
Your answer
Proposed meet-up location for your team to connect before heading to the action
Your answer
Date of planned "Drop by" NY Health Lobby Visit
MM
/
DD
/
YYYY
Which state legislator(s) do you plan to visit?
Your answer
Will you need materials? *
Will you need help recruiting other local activists to join you? *
If you already have a team for your planned visit, please let us know who you expect to join you, full names with their emails or phone numbers: *
Your answer
If you are planning your visit as part of an organization, please list the organization: *
Your answer
Will you be able to capture images or video from your lobby visit to share via social media?
Any other comments or questions?
Your answer
Thank you for submitting your canvassing event! We will followup with you about materials and details for your event.
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