Albany Days Application for NYCHC
Your story can help influence public policy at the state and local level! Join bleeding disorders advocates from across New York for Albany Days from Saturday, March 18 to Monday, March 20.

Whether you are new to advocacy, or you're an experienced advocate, you can help us make a difference! This three-day program will feature a fun and interactive advocacy training followed by meetings with your Senator, Assemblymember or their staff. 

Space is limited. We expect to be able to fund five families to attend from our chapter. Below is an application to express interest in attending this event.  

Applications will be accepted until Friday, February 10 at 5 PM. 
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Your Name
Full Mailing Address
Cell Number
Email Address
What is your connection to the bleeding disorders community?
Do you or any of your immediate family members work for a pharmaceutical or specialty pharmacy company?
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How many people in your family will attend this event? 
Please list the names and ages of each person in your family who will be attending.
Would you like the chapter to cover transportation to and from Albany for you or your family?
Clear selection
Why do you want to attend this event?
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