2021 HNBA Week of Action Interest Form

2021 HNBA WEEK OF ACTION INTEREST FORM

Thank you for your interest in the 2021 HNBA Week of Action. Please complete the form below to receive receive information on how to contact your congressional offices, messaging guidance and the social media toolkit. You will receive a confirmation of your submission to your e-mail (be sure to check your junk/spam filter).

Name*

First

Last

Professional Title:*

Company/Organization:*

Address of Residence*

City State / Province / Region Postal / Zip Code

Hometown (if different from above):

City State / Province / Region Postal / Zip Code

Phone:*

Area Code

Phone Number

E-mail:*

Please indicate your practice area(s) and identify any sub-specialties:*

Please select the topics you have most experience in or are most interested in advocating for: *

Immigration

Voting Rights

Criminal Justice Reform

COVID Relief

Federal Judiciary

Puerto Rico

In what state are you registered to vote?*

Are you a U.S. Citizen?*

YES

Are you active military or a veteran?*

YES

Are you an active, dues paid HNBA member?*

YES

Please indicate your category of HNBA membership or professional level that defines you best:

Attorney

Student

Judge

Other

Please identify any members of Congress and Senators you have significant connections with and describe the connection:

Please complete the addition math captcha below.

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