2027 PA Day at the Capitol — Student Registration
Complete this registration to be considered for PA Day at the Capitol and receive final event instructions by email.
Student Information
First name
*
Last name
*
Preferred name
Email address
*
example@example.com
Mobile phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred method of contact
*
Email
Text message
Either
PA Program Information
PA Program or School
*
Please Select
Carroll University
Concordia University Wisconsin
Marquette University
University of Wisconsin–La Crosse
University of Wisconsin–Madison
Other
If other, please specify your PA program or school
Current year or stage in PA program
*
First-year/didactic student
Second-year/clinical student
Third-year student
Other
Expected graduation month and year
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PA program coordinator or faculty contact name
*
First Name
Middle Name
Last Name
PA program coordinator or faculty contact email
*
example@example.com
Participation and Membership
Are you currently a WAPA student member?
*
Yes
No
Unsure
Have you participated in PA Day at the Capitol before?
*
Yes
No
If yes, approximately what year or years did you participate?
What are you most interested in learning or experiencing at PA Day at the Capitol?
Accessibility and Accommodations
Accommodation information will be reviewed only by individuals involved in event planning and will be used solely to support your participation.
Does the student need any accessibility assistance, dietary consideration, or other reasonable accommodation to participate?
*
No
Yes
Prefer to discuss privately
Please describe the accommodation or assistance that would help you participate. Do not include medical information beyond what is necessary for event planning.
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship to Participant
*
Please Select
Parent
Guardian
Spouse
Sibling
Relative
Friend
Other
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Acknowledgments
Acknowledgment of registration and email instructions
*
I understand that submitting this form registers my interest in participating and that WAPA will provide final event instructions by email.
Acknowledgment of appointment and pairing coordination
*
I understand that legislative appointments and PA pairings will be coordinated by WAPA and may be subject to change.
Acknowledgment of attendance changes
*
I agree to notify WAPA promptly if I register but later become unable to attend.
Acknowledgment of photography and video
*
I understand that photographs or video may be taken during the event.
Photography preference
I prefer not to be individually photographed or recorded.
Electronic signature
*
Submission date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Registration
Submit Registration
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