CCJR Lobby Day Signup
Name: *
Your answer
Email Address: *
Your answer
Cell Phone (with area code!): *
Your answer
Your answer
Need a ride on the bus coordinated through CCJR? (The bus will be leaving on Wednesday, February 4th and will arrive in Tallahassee that afternoon/evening. Dinner will be provided upon arrival. Please make accommodations to be dropped off. Only one bag per rider.) *
If you need bus pickup, please provide the city you need pickup from:
Your answer
Will you need hotel accommodations? (Please understand you may be rooming with someone else.) *
If you need hotel accommodations, would you like to apply for a room scholarship?
If you are attending with someone else and are willing to share a room with them, please list their name:
Your answer
Do you have any dietary restrictions (vegan, vegetarian, gluten-free, etc)? If so, please list them below.
Your answer
Do you require accessible accommodations? *
If you require accessible accommodations, please let us know how we can support your needs:
Your answer
What size T-shirt do you wear? *
Who is your state senator? If you don't know, you can look it up here: *
Your answer
Who is your state representatives? If you don't know, you can look it up here: *
Your answer
Have you ever attended your local delegation hearing or spoke before the delegation on criminal justice reform? *
Have you attended or do you plan to schedule and attend an In-District Meeting with your Legislator on our issue (85% Rule)? *
Have you attended a lobby day before? *
Your story is powerful and could truly make a difference when talking with Legislators. Are you willing to share your personal story about the effect that the 85% rule and racial disparities have had in your life as a impacted individual or family member and stress the importance of Criminal Justice Reform?
Would you like to sign up for our CCJR newsletter? *
Never submit passwords through Google Forms.
This form was created inside of Southern Poverty Law Center.