Please complete this form to register for the 2009 Women's Advocacy Day, April 1 in Raleigh. If you have difficulty with this form, you can use the printable form and 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) AAUW NC Adolescent Pregnancy Prevention Campaign of NC Buncombe County Women's Commission Carteret County Women's Resource Center Democracy North Carolina Equality NC Greensboro Commission on the Status of Women Interact Ipas League of Women Voters of NC Mecklenburg County Women's Commission NARAL Pro-Choice North Carolina National Association of Social Workers NC Chapter NC Association of Women Attorneys NC Business and Professional Women Foundation NC Center for Women in Public Service NC Coalition Against Domestic Violence NC Coalition Against Sexual Assault NC Friends of Midwives NC Justice Center NC National Organization for Women NC Women Work! NC Women's Political Caucus Onslow County Council for Women Orange County Commission for Women Planned Parenthood Health Systems Planned Parenthood of Central North Carolina Triangle MomsRising Triangle Older Women's League WomenNC - NC Committee for CSW/CEDAW Women's Forum of NC Women's Resource Center - Hickory Women's Resource Center in Alamance County
Yes, I will attend the training and register at the church
No, I will not attend the training and will register at the Legislative Building
Please tell us who represents you. (You can find your district number on your voter registration card.)
NC House:
NC Senate:
Check here if you need help scheduling an appointment with your legislators.
We value your privacy and will not use the above information except as necessary for coordination of 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.
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 as charitable contributions.
Amount:
Payment method: Check; check #: Credit card or PayPal
