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Registration Form - Florida Advocacy Day *Full Name: Home Address: City: Zip: Email Address: Phone: Teaching Level: ¡ Elementary ¡ Middle ¡ Secondary ¡ College ¡ Other If you selected “Other” above, please specify: School Affiliation: **Please list your state Senator: **Please list your House Representative and District: **See http://www.flsenate.gov/Legislators/index.cfm?Mode=Find%20Your%20Legislators&Submenu=3&Tab=legislators&CFID=182044040&CFTOKEN=68690078 to locate your legislators. Will you need overnight accommodations? ¡ Yes ¡ No Are you interested in carpooling? ¡ Yes ¡ No * Please bring your business card or calling card that you can leave with your contact information. Return this form to:
Clarissa N. West-White
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