Please complete this form to register for the 2006 Women's Advocacy Day, June 20 in Raleigh. If you have difficulty with this form, you can register by mail.
Name:
Street Address:
City:
State:
Zip:
Email:
Your home county Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville Greene Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancy
Primary Organization (if NCWU member) Adolescent Pregnancy Prevention Coalition of NC American Association of University Women NC Brunswick County Council for Women Business and Professional Women of NC Carteret County Women's Resource Center Council for Women/Domestic Violence Comm. Democracy North Carolina Equality NC General Federation of Women's Clubs of NC Greater NC Coalition of Labor Union Women Greensboro Comm. on the Status of Women Interact Ipas League of Women Voters of NC Lillian's List of NC Mecklenburg Commission on Women Meredith College NARAL Pro-Choice NC National Association of Social Workers NC Chapter Nat'l Council of Negro Women NC Coalition NC Association of Women Attorneys NC Coalition Against Domestic Violence NC Coalition Against Sexual Assault NC Gay and Lesbian Attorneys NC Hunger Network NC Justice Center NC National Organization for Women NC Women Work Onslow County Council for Women Orange County Department of Human Rights Peace College Planned Parenthood of Central North Carolina Task Force on Family Violence/REACH, Inc Triangle Older Women's League The Sisko Foundation The Women's Center [Triangle/Chapel Hill] WILPF-Triangle Women's Forum of NC Women's Resource Center in Alamance County Women's Resource Center - Hickory
We value your privacy and will not use the above information except as necessary for coordination of the 2006 Women's Advocacy Day unless you check one or both of these boxes:
Yes, please notify me of future Women's Agenda Assemblies and Women's Advocacy Day related events.
Yes, please subscribe me to the NC Women United "alerts" list.
Yes, please contact me about organizing an Agenda Assembly in my county.
My representative in the House:
My representative in the Senate:
There is no charge for the Advocacy Day event, but we welcome you to make a contribution to NC Women United to support this and other efforts. Five dollars would defray the expenses of producing a packet for you and your legislators. Those contributing at least $35 ($15 for students) will be recognized as "Friends of NCWU". Any amount is appreciated! NC Women United is a 501(c)(3) organization and contributions are tax-deductible.
Amount:
Payment method: Check; check #: Credit card or PayPal
