#MedicalNutritionEquityNow Hill Day Registration Confirmation Please fill out this form once for EACH attendeed at the #MedicalNutritionEquityNow Hill Day. For children, use the voting address and email address of their parent/guardian.Attendees's Name* First Last Please confirm the following:* Yes, I plan to attend the #MedicalNutritionNow Hill Day No, my plans have changed and I am unable to attend Is the attendee a minor (under 18 years old)* No Yes Name of Parent or Accompanying Guardian* Attendee's Age* Attendee's Email Address* Attendee's Email Address (if applicable) Attendee's Cell Phone Number*Attendee's Cell Phone Number (if applicable)Attendee's Voting Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attendee's Voting Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I will be staying at the following hotel* I will be arriving in time for the 3pm required training session at the Capitol Skyline Hotel on Monday, May 6* Yes No Please indicate when you will arrive* I will be leaving DC after 6:30pm on Tuesday, May 7* Yes No Please indicate when you will be leaving DC* I understand that by submitting this form I am cancelling my registration for the #MedicalNutritionEquityNow Hill Day* Yes If you registered for others and need to cancel their registrations as well, please enter their names below.I understand that the Patients & Providers for Medical Nutrition Equity Coalition will be booking all of my meetings on Tuesday, May 7 and I should attend only my assigned meetings.* I agree Please include any additional comments including whether the attendee is a child, and/or has accessibility requirements. Δ