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NACDS RxIMPACT Hill Day Advocate Registration
NACDS RxIMPACT Hill Day Advocate Registration
Michael Silber
2023-12-01T14:37:46-05:00
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Registrant Details
Your Name
(Required)
First
Last
Suffix
Nickname
Company Name
(Required)
Title
(Required)
Email Address
(Required)
Cell Phone
(Required)
Capitol Hill Appointments
Home Mailing Address:
(Required)
To schedule meetings with the Members of Congress representing the address where you live and vote, please provide your home address below, as this address is required by policymakers to schedule your meetings. This information will not be used for any other purpose than scheduling meetings and will not be distributed. Important note: Members of Congress will not schedule appointments with individuals listing PO Boxes or mailstops, as these are not acceptable addresses for voter registration.
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Work Address:
(Required)
To increase the number of meetings we can schedule on your behalf, please also provide a second address, your physical work or school address, for us to schedule a meeting with the policymakers representing these areas. This secondary address is important as your place of business provides goods and/or patient care services to constituents in the policymaker’s district. This information will not be used for any other purpose than scheduling meetings and will not be distributed. Important note: Members of Congress will not schedule appointments with individuals listing PO Boxes or mailstops, as these are not acceptable addresses.
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Have you participated in past NACDS RxIMPACT Day events?
Yes
No
I would be interested in serving as a Team Leader?
Yes
No
If there are any Members of Congress you would like to specifically meet with, please provide more information.
Please note any disability, food, or scheduling requirements.
2024 Event Activities
Pioneer Celebration Reception March 13th 6:30pm-7:30pm
(Required)
Yes
No
Welcome Dinner March 13th 7:30pm-9:30pm
(Required)
Yes
No
Breakfast Briefing March 14th 7:30am-8:30am
(Required)
Yes
No
Attend Capitol Hill Appointments March 14th 9:45am-5:00pm
(Required)
Yes
No
Lunch When Works in Schedule March 14th 11:00am-4:30pm
(Required)
Yes
No
Closing Reception March 14th 5:00pm-6:00pm
(Required)
Yes
No
Capitol Hill Appointments
(Required)
Yes, I understand NACDS will be scheduling appointments on my behalf.
I agree to the terms and conditions.
Event Photos Disclosures
(Required)
Yes, I understand event photos will be taken throughout event activities and such images may be utilized in various publications and social media communications.
I agree to the terms and conditions.
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