The Optical Society - CongressionalVisitsDay

Congressional Visits Day 2013 Sign Up Form

All fields are required.

Name:
Email:
Company/University:
Home Address:
Work Address:
Often times, you may live and work in different Congressional Districts. When this happens, we try to schedule you to meet both Members, thus spreading our message across a larger audience.
Cell Number:
I would like to participate in Congressional Visits Day 2012 on March 12 & 13:	Yes No
All new Congressional Visits Day participants are required to attend the training sessions on the morning of March 12 at OSA Headquarters - your meeting schedule, briefing materials, name badges, and other important information will be provided at the time.
	Yes, I can attend training. No, I can not attend training.
Have you previously participated in Capitol Hill visits through OSA or other organizations?:	Yes No
If yes, with whom?:
Are you a student?:	Yes No
	Checking this box certifies that I understand the dates of the Congressional Visits and the responsibilities that attending requires. I understand that the visits are being scheduled on my behalf and if for any reason I am unable to attend the Congressional visit arranged for me, I will notify the OSA Government Relations team (public-policy@osa.org) no later than March 5, 2013. YOUR PARTICIPATION IS NOT CONFIRMED UNTIL YOU RECEIVE A CONFIRMATION EMAIL FROM SARAH COGAN. IN THE EVENT THAT YOU DO NOT RECEIVE CONFIRMATION, PLEASE CONTACT SARAH DIRECTLY AT scogan@osa.org
Form Check: