2024 Immunize Kansas Coalition Advocacy Day Registration

Thursday, January 25, 2024
Kansas State Capitol
201 SW 8th Ave, Topeka, KS 66603

Please fill out your attendance plans, and we will be in touch with further details about the day!

1/22/24 note: New registrants welcome, but we are past the catering deadline; breakfast and lunch are not guaranteed.

Question Title

* 1. Name

Question Title

* 2. Organization (if applicable)

Question Title

* 3. Email

Question Title

* 4. Cell Phone (for unexpected, last-minute updates)

Question Title

* 5. Home Address (to help us determine your legislative district): (Those who live in Missouri or out-of-state, there is a place for you, too!)

Line 1:

Line 2:

City:

State:

Zip:

Question Title

* 6. T-Shirt Size (we may get T-Shirts for the group)

2XL

List any special sizing notes:

Question Title

* 7. Breakfast (8:30 - 9:30 a.m.)
1/22/24 note: past catering deadline. Breakfast not guaranteed for new registrants

Yes, will attend

No, unable to attend

Other/comment (please explain):

Question Title

* 8. Available to attend morning activities (9:30 a.m. - Noon)?
There will be something for everyone. Expected opportunities include advocacy day training, observing legislative meetings, visiting lawmakers, staffing IKC table, etc. - more details will be shared closer to date.
1/23/2024 note: We are currently at capacity for breakfast and training at KHI Learning Center, 8:30-10:30. Some advocates can instead observe legislative meetings during this time. Watch for emailed instructions.

Yes, available to attend

No, unable to attend

Other/comment (please explain):

Question Title

* 9. Lunch in 1st Floor North Wing (Noon - 1 p.m.)
1/22/24 note: past catering deadline. Lunch not guaranteed for new registrants

Yes, will attend

No, unable to attend

Other/comment (please explain):

Question Title

* 10. Please list any special dietary needs:

Question Title

* 11. Available to attend afternoon activities (1:00 - 3:30 p.m.)?
Expected opportunities include attend IKC press conference, listen to speakers, observe legislative meetings, visit lawmakers, or help staff IKC table. More details will be shared closer to the date.

Yes, will attend

No, unable to attend

Other/comment (please explain):

Question Title

* 12. Are you willing to talk with a lawmaker about why immunizations are important for protecting Kansans?
We will provide talking points and help divide participants into small groups.

Yes

Maybe, I'd like more information first

Question Title

* 13. We need help! Are you willing to assist with planning and/or staffing efforts? (check all that apply) If so, we'll be in touch with more details.

I only want to attend as a participant this time, thanks!

I'm willing to help staff an IKC information table in the Rotunda

I'm willing to help deliver educational materials to lawmakers' offices

I'm willing to help match registered attendees to their lawmakers and plan small groups (will finalize day-of)

I'm willing to lead a small group around the statehouse to visit lawmakers and/or observe legislative meetings

I'm willing to help staff/monitor the breakfast or lunch service

Other/questions:

Question Title

* 14. If not already, would you like to engage with IKC in one or more of the following ways?

I already engage with IKC in all the ways I would like

Subscribe me to the IKC newsletter and action alert emails

Send me calendar invites for IKC meetings

Contact me with more information about IKC membership

Other (please specify)

Question Title

* 1. Name

Question Title

* 2. Organization (if applicable)

Question Title

* 3. Email

Question Title

* 4. Cell Phone (for unexpected, last-minute updates)

Question Title

* 5. Home Address (to help us determine your legislative district): (Those who live in Missouri or out-of-state, there is a place for you, too!)

Question Title

* 6. T-Shirt Size (we may get T-Shirts for the group)

Question Title

* 7. Breakfast (8:30 - 9:30 a.m.)1/22/24 note: past catering deadline. Breakfast not guaranteed for new registrants

Question Title

Question Title

* 9. Lunch in 1st Floor North Wing (Noon - 1 p.m.)1/22/24 note: past catering deadline. Lunch not guaranteed for new registrants

Question Title

* 10. Please list any special dietary needs:

Question Title

* 11. Available to attend afternoon activities (1:00 - 3:30 p.m.)?Expected opportunities include attend IKC press conference, listen to speakers, observe legislative meetings, visit lawmakers, or help staff IKC table. More details will be shared closer to the date.

Question Title

* 12. Are you willing to talk with a lawmaker about why immunizations are important for protecting Kansans?We will provide talking points and help divide participants into small groups.

Question Title

* 13. We need help! Are you willing to assist with planning and/or staffing efforts? (check all that apply) If so, we'll be in touch with more details.

Question Title

* 14. If not already, would you like to engage with IKC in one or more of the following ways?

Question Title

* 15. Other comments or questions:

* 7. Breakfast (8:30 - 9:30 a.m.)
1/22/24 note: past catering deadline. Breakfast not guaranteed for new registrants

* 9. Lunch in 1st Floor North Wing (Noon - 1 p.m.)
1/22/24 note: past catering deadline. Lunch not guaranteed for new registrants

* 11. Available to attend afternoon activities (1:00 - 3:30 p.m.)?
Expected opportunities include attend IKC press conference, listen to speakers, observe legislative meetings, visit lawmakers, or help staff IKC table. More details will be shared closer to the date.

* 12. Are you willing to talk with a lawmaker about why immunizations are important for protecting Kansans?
We will provide talking points and help divide participants into small groups.