2023 Legislative Education Event Registration

Name(Required)

First Last

Email(Required)

Phone(Required)

Street Address(Required)

Physical address where you live, not mailing address/PO Box, or employer address. This is important, as we try to schedule volunteers for meetings with their own legislators.

Street Address City State ZIP Code

Connection to the Donate Life NYS mission (select all that apply)(Required)

Recipient of Organ, Eye, and/or Tissue Transplant

Relative or Friend of Deceased Organ, Eye, and/or Tissue Donor

Living Donor

Donation/Transplant Professional

Other

Type of Transplant (select all that apply)(Required)

Cornea Recipient

Heart Recipient

Liver Recipient

Lung Recipient

Kidney Recipient

Intestines Recipient

Pancreas Recipient

Tissue Recipient (non-cornea)

Relation to Donor(Required)

ie/ Mother, father, brother, sister, grandmother, grandfather, aunt, uncle, etc.

Name of Donor

First Last

Type of Living Donation (select all that apply)(Required)

Kidney Donor

Liver Donor

Other

Type of Living Donation (Other)(Required)

Please indicate what you donated

Connection to Recipient(Required)

Relation to Recipient(Required)

ie/ Mother, father, brother, sister, grandmother, grandfather, aunt, uncle, etc.

Connection to Recipient (Other)(Required)

Please explain your connection to the recipient of your living donation

Employer(Required)

Name of donation or transplant organization where you work

Job Title(Required)

Connection to Donate Life NYS Mission (Other)(Required)

Please explain your connection to organ, eye, and tissue donation

IMPORTANT NOTE- Please read the following information prior to selecting availability

CONSTITUENCY-BASED MEETINGS
Meetings for this event are constituency-based and we make every effort to schedule volunteers with their own legislators. However, due to constraints with legislators' availability as well as multiple volunteers sharing the same legislator(s), we are unable to guarantee these constituency-based meetings will match your availability. Please be assured we will schedule you only for meetings on the dates and times you indicate you are available.

IN-PERSON OPTION (TUESDAY ONLY IN ALBANY):
A limited number of meetings will be scheduled as in-person visits. To attend in-person on Tuesday, May 2, 2023, we ask that you ensure you are available all day (9:00 a.m. until 5:00 p.m.). We cannot guarantee that all volunteers who indicate their availability to attend in-person will be able to do so. To allow us the greatest flexibility in scheduling, if you are available all day on Tuesday, May 2nd and do not have a preference on whether you attend in-person or virtually, please select both options.

Availability (select all that apply)(Required)

PRIOR TO SELECTING AVAILABILITY, PLEASE READ THE "IMPORTANT NOTE" ABOVE. Select the dates/times you are available to participate in meetings with legislators. For each date you indicate availability, please ensure you select the appropriate box specifying whether your availability is all day or limited.

(VIRTUAL) Monday, May 1, 2023, anytime between 9:00 a.m. and 5:00 p.m

(VIRTUAL) Monday, May 1, 2023, but with time restrictions

(VIRTUAL) Tuesday, May 2, 2023, anytime between 9:00 a.m. and 5:00 p.m

(VIRTUAL) Tuesday, May 2, 2023, but with time restrictions

(IN-PERSON, ALBANY) Tuesday, May 2, 2023: Select this in-person option only if you are available all day without time restriction

(VIRTUAL) Wednesday, May 3, 2023, anytime between 9:00 a.m. and 5:00 p.m

(VIRTUAL) Wednesday, May 3, 2023, but with time restrictions

List the time(s) you ARE available to participate in virtual meetings on Monday, May 1, 2023(Required)

Example: Between 9:30 a.m. and 11:00 a.m., or Anytime after 1:00 p.m.

List the time(s) you ARE available to participate in virtual meetings on Tuesday, May 2, 2023(Required)

Example: Between 9:30 a.m. and 11:00 a.m., or Anytime after 1:00 p.m.

List the time(s) you ARE available to participate in virtual meetings on Wednesday, May 3, 2023(Required)

Example: Between 9:30 a.m. and 11:00 a.m., or Anytime after 1:00 p.m.

Additional Information

Please let us know if there is any additional information you'd like to provide us

2023 Legislative Education Event Registration

Register for 2023 Legislative Education Event