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Have you participated previously in a Voices for National Service Capitol Hill Day?

Yes
No
Name **
Title
Organization or Program **
National Service Affiliation (e.g., AmeriCorps, Learn and Serve America, Senior Corps, State Commission)
Email Address **
Work Phone **
Cell Phone (Please note: Congressional offices must often change scheduled meeting times or room locations based on the events of the day. We will use your cell phone information during the Hill Day to communicate these changes.)
Please list below each individual from your organization planning on participating:
We expect that all Hill Day participants will make themselves available from 9:00 AM to 5:00 PM on September 15th. Please list below any time conflicts you will have:
Voices for National Service expects a record number of participants for the 2011 Capitol Hill Day. To ensure a successful Capitol Hill Day for such a large group, each participant will be pre-assigned to a team based on home state. If you represent a national organization, with affiliate sites in more than one state, you will still be assigned to one team, which will attend meetings as a delegation. For planning purposes, please list below the community and state where your program is based. If you represent a national organization, please list and rank up to three service states in order of strongest programming or presence by your organization. Voices for National Service will be responsible for setting up all of the appointments for each state delegation and will coordinate schedules to meet the needs of all participants. **

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