American Cancer Society Cancer Action Network: Survey

2009 ACS CAN Arizona Lobby Day

Please register for the ACS CAN Arizona Lobby Day 2009

Name:

Title	First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number:

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Question - Not Required - Have you attended a previous Arizona Lobby Day?

Question - Required - Are you a member of ACS CAN?

Question - Not Required - ACS CAN polo shirts MAY be available for purchase at the event. Would you be interested in purchasing a polo shirt? If yes, what size?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Do you require a vegetarian meal?

Question - Not Required - Do you have a personal relationship with any state lawmaker(s)? If yes, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

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ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit acscan.org.

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