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CTIPP CAN: Individual Campaign Sign-Up

Thank you for your interest in joining the nationwide grassroots campaign to engage congressional offices and other federal leaders in supporting policies, programs, legislation, and appropriations that prevent and respond to childhood trauma and build resilience. The following questions will help us better maximize your time and engagement.

Please email Laura Quigley (laura@traumacampaign.org) for help or if you have any questions.

First Name*

Last Name*

Email*

Mailing Address, line 1*

Mailing Address, line 2

City*

State*

Zip Code*

Organization (if applicable - type n/a if you're signing up as an individual)*

Is your organization a member of any relevant coalitions? (type n/a if no)

What sector do you represent? (skip if not applicable)

Is there an additional sector you represent? (skip if not applicable)

Other

What is your Congressional district number? (E.G., 02 for CA-02 or 26 for NY-26) Visit https://www.house.gov/representatives/find-your-representative for help.*

I agree that you can share my name and email with local Campaign stakeholders for the purposes of coordinating actions and opportunities related to the Campaign. I understand that I may choose whether or not I become involved in coordinated actions on a case-by-case basis. I further understand that I can contact the Campaign at traumacampaign@gmail.com at any time to rescind this agreement.*

Yes No

We will never share your email address without your permission. Ever.