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PCOS Challenge State Legislative Advocacy Volunteer Form
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PCOS Challenge: The National Polycystic Ovary Syndrome Association is seeking volunteers to help with our state legislative advocacy efforts. Please complete the form below to request additional information. No previous legislative advocacy experience is required. We will provide you with training, so that you a fully prepared for any meetings or activities.
First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Phone
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Please use format XXX-XXX-XXXX
Your answer
Address
*
Your answer
Suite/Apartment/Unit
Your answer
City
*
Your answer
State
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Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
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Your answer
Do you have any legislative advocacy experience?
*
No previous advocacy experience is required. We will provide you with training, so that you a fully prepared for any meetings or activities.
Choose
I'm a first time advocate.
Some local or state advocacy
Some federal advocacy
Some federal and local or state advocacy
Extensive local or state advocacy
Extensive federal advocacy
Extensive federal and local or state advocacy
Where is your state's capitol?
*
Choose
AK - Juneau
AL- Montgomery
AR - Little Rock
AZ - Phoenix
CA - Sacramento
CO - Denver
CT - Hartford
DE - Dover
FL - Tallahassee
GA - Atlanta
HI - Honolulu
IA - Des Moines
ID - Boise
IL - Springfield
IN - Indianapolis
KS - Topeka
KY - Frankfort
LA - Baton Rouge
MA - Boston
MD - Annapolis
ME - Augusta
MI - Lansing
MN - St. Paul
MO - Jefferson City
MS - Jackson
MT - Helena
NC - Raleigh
ND - Bismarck
NE - Lincoln
NH - Concord
NJ - Trenton
NM - Santa Fe
NV - Carson City
NY - Albany
OH - Columbus
OK - Oklahoma City
OR - Salem
PA - Harrisburg
RI - Providence
SC - Columbia
SD - Pierre
TN - Nashville
TX - Austin
UT - Salt Lake City
VA - Richmond
VT - Montpelier
WA - Olympia
WI - Madison
WV - Charleston
WY - Cheyenne
Do you live within driving distance of your state's capitol?
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You can still volunteer if you do not live near your state's capitol.
Choose
Yes
No
Would you be willing to meet with members of your state's legislature?
*
No previous advocacy experience is required. We will provide you with training, so that you a fully prepared for any meetings with legislators or their staff.
Choose
Yes
No
Comments (Optional)
Your answer
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