2024 Rally for Medical Research Participant Sign-Up General Information Registration Deadline: September 4, 2024 2024 Participant Guidelines Website Question Title * 1. Please enter your full name First Name Last Name Suffix (MD, PhD, Jr., Sr., etc.) Question Title * 2. Business Name / Organization (if applicable) Title/Role (if applicable) Affiliated Organization Question Title * 3. Please provide your home address. Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country Question Title * 4. Please provide a contact number in order to reach you while in Washington, DC with any day-of-the-Rally changes. Question Title * 5. Email Address Question Title * 6. Please provide your business address. Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country Phone Number * Question Title * 7. Have you participated in a Hill Day before? Yes No Question Title * 8. What events will you participate in during the 2024 Rally for Medical Research? Rally for Medical Research Training (3:00 pm - 5:00 pm Wednesday, September 18) Holiday Inn Washington Capitol, Washington, DC Reception to Celebrate Medical Research (6:00 pm - 8:00 pm Wednesday, September 18) Capitol Hill, Washngton, DC Rally for Medical Research Breakfast (7:00 am - 9:00 am Thursday, September 19) Holiday Inn Washington Capitol, Washington, DC *Please note that attendance at both the Rally for Medical Research Training and Breakfast is highly recommended, especially for first-time Rally participants. Question Title * 9. Are you interested in hotel accommodations in Washington DC for the Rally for Medical Research? Yes No Question Title * 10. Do you have any special relationships with House or Senate offices? If yes, list office(s). Next