New York State Association of Community and Residential Agencies

LEGISLATIVE DAY 2009
SIGN UP SHEET

Event Date:

 Tuesday, January 27th, 2009

 

Please complete this form by December 31, 2008, print it out & mail or fax to:

NYSACRA - Attention: Forest Cotten
240 Washington Avenue Ext., Suite 501, Albany, New York 12203, FAX: (518) 449-1509

AGENCY NAME: _________________________________________________________________________________

TEAM LEADER NAME: __________________________________________________________
TEAM LEADER ADDRESS: _______________________________________________________

PHONE # (____) ___________________ Ext. _____  FAX # (____) ______________________

E-MAIL: _____________________________________

 

TEAM MEMBERS NAMES (N) & ADDRESSES (A)

1. N _________________________        A ___________________________

2. N ________________________         A. ___________________________

3. N ________________________         A. ___________________________

Others:  _________________________________________________________________________________ (Add sheets if needed or email info)

 

If you know which State legislators you want to see, please list them below:

Senator _________________________ Assemblyperson _______________________

Senator _________________________ Assemblyperson _______________________

 

If you have any suggestions to make your 2009 Legislative Day better, please write them
below or call NYSACRA ext 24.  (Attach additional sheets if necessary) _________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

If you have any questions, please call Forest Cotten (518) 449-7551 ext 24; or Email him at forest@nysacra.org.