Advocacy for Change 2016 - Family Voices of WI

Family Voices of Wisconsin
Advocacy for Change - A Family Leadership Institute
March 3, 2016, 8:30 - 4:30, Concourse Hotel, Madison
Full Name

First NameLast Name
Address

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CityState / Province

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Preferred Telephone Number

Area CodePhone Number
Is this telephone number:

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Age(s) and disability of child/children
What would you like to learn at this leadership event?
What issue would you like to talk with your Legislators about?
Have you ever participated in:

Conferences (e.g., Circles of Life, Autism Society)Committees or Advisory GroupsProvided testimonyCommunicated with legislators or other elected officialsAdvocacy or Leadership trainingOther related leadership activities
Are you willing to work with Family Voices to connect with other families around advocacy and communicating with policy makers?*

YesNo
Will you need a hotel room on March 2nd (paid for by Family Voices)?

YesNo
Will you need additional support or accommodations to participate in this event? (Family Voices will pay for meals, parking and travel). If yes, please explain.
After submitting this form you will receive a confirmation email from Family Voices. We will then contact you to arrange your hotel reservation and provide additional details about the event. If you have questions, contact Lynn at lynn@fvofwi.org or 608-828-9959.

Please review the PARTICIPANT AGREEMENT - available on the Family Voices website under Advocacy for Change (www.familyvoicesofwisconsin.com)
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Family Voices of Wisconsin

Advocacy for Change - A Family Leadership Institute

March 3, 2016, 8:30 - 4:30, Concourse Hotel, Madison