PCOS Advocacy 2020 - Advocate District Meeting Registration Form
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Overview - Supporting as a Local Advocate
If you are unable to attend PCOS Advocacy Day in Washington, DC on March 12th (pcos.ch/advocacy), but would like to support our efforts by meeting with your Congressperson at their home district office near you, please register using the form below. We will provide you with training and advocacy materials for your meeting.

IMPORTANT SCHEDULING NOTE:
We will attempt to schedule a meeting with your Congressperson's office between May 4th - May 29th based on your local office's availability.

DONATIONS:
Coordinating Advocacy Day and local meetings takes significant resources. Please consider making a donation to support our efforts at pcoschallenge.org/giving/

PRIVACY STATEMENT:
PCOS Challenge respects your privacy and is committed to keeping your personal information confidential.
Please Complete the Form Below to Register
First Name *
Last Name *
Email Address *
Mobile Phone *
In case we need to contact you regarding your meeting.
Organization/Company
If Applicable
PRIMARY ADDRESS
Please list your primary address or the address where you are registered to vote.
Address *
Suite/Apartment/Unit
City *
State *
Zip Code *
Meeting Availability
Which days can you be available all day (8:00am-5:00pm) to go to your Representative's home district office? Check all that apply. *
Required
I understand that I am responsible for arranging my own transportation to and from my Representative's home district office. *
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