Day at the Capitol 2019

Day at the Capitol 2019







Which event(s) will you attend?

Full Name:

Organization/School:

Organization/School Street Address

Organization/School Street Address Line 2

City

State

County

Zip code

Region NWSWAlleghenyNCSCNESEPhiladelphiaStatewide

Cellphone number (for day of event)

Email

Adult T-shirt Size

Special Accommodations

Do you have a personal relationship with any of your legislators? YesNo

Additional Adult Chaperone

Full Name: Email:

We have boxed lunches available for this year. If you are interested, please let us know the number of lunches you are requesting:

Tru Youth/Student Information

Please enter the name, HOME address, phone number, email address and region for each student you plan to bring along with you. NOTE: Only 15 students maximum per Adult Advisor.

Student Full Name:

Home Address

City

Zip code

County

Student T-shirt Size

Emergency Contact Person

Special Accommodations

Organization/School:

Address Line 2

State

Region

Email

Phone number

Emergency Contact Phone

+ Add Another Student