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Dentists at the Capitol RSVP

Thanks for joining us for CDA's Dentists at the Capitol State Lobby Day on Friday, February 17, 2012 at 10:00 a.m.! Please complete the RSVP form below, which will help us provide you with the best experience possible.
 

Please provide the following RSVP information:
- name,
- degree (DDS or DMD),
- best email for information about the event, and
- home address (so we can determine your correct legislators)
First Name:
Last Name:
Job Title:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Are you interested in taking a shuttle bus to the Capitol?
Yes, I would like to park at the CDA and take a shuttle to the Capitol
Yes, I would like to park at the CU Dental School and take a shuttle to the Capitol
No, I will drive separately

Do you have any special dietary needs (for the free box lunch)?
No
Yes, please specify in the "other" field below
Other  

Will you participate in the optional Capitol tour and legislative process overview following your meeting with legislators?
Yes
No