Registration Form
Please Note: While our official registration deadline has passed, we still welcome you! This is a sign-on for Walk-in registrants - so you will need to check-in when you arrive at the event at the walk-in table. However, this allows us to 'fill the bus' that is coming from Southeast Florida on 2/5, our carpool coming from Brevard on 2/5, our bus coming from Orlando on 2/6, and our vanpool from Gainesville on 2/6, and allows us to do our best to make sure you are scheduled for legislative appointments.

So, thanks for taking the time to fill this out!

We're looking forward to meeting you, and joining forces in the fight to RECLAIM FLORIDA'S FUTURE FOR ALL! This short survey will let us know more about you, and where you will be able to contribute the most during "Reclaiming Florida's Future for All." Your input is important to us, and it is our hope that you will enjoy participating.
Sign in to Google to save your progress. Learn more
First Name: *
Last Name: *
Phone Number: *
Email address: *
Physical address *
We will not share your address with any third party. The purpose of this question is to verify your Florida Legislative representatives.
Zip *
City *
County *
Who is your representative at the State House? *
Who is your State Senator? *
Hint: Not Marco Rubio or Bill Nelson. If you're unsure, you may check at: https://www.flsenate.gov/senators/find
How will you be traveling to Tallahassee? *
Where will you be staying Feb. 5th? *
For a bed/ mattress at the Center, please include your payment at the end of this survey
Will you contribute $25 to offset transportation and food costs? *
We want to make this accessible to everyone, but if you are able to offset transportation and food costs, please indicate below. If another amount, please indicate that in 'Other'
This is a group event, hosted by several organizations that have come together to provide a positive experience for you. Please review the agreements in the link below, and let us know that you agree to them. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms