Date
* First Name
Middle Initial
* Last Name
I am a
* Job Title - As you would like to appear on your badge
Team Name or Display, Other
How and/or who recruited you?
Current Address(campus dept. & location if staff/faculty member):
Email
Phone Number
Home :- (xxx-xxx-xxxx)
Work :- (xxx-xxx-xxxx)
Please select one
Male Female
Cell phone number if you plan to bring it with you to BU Advocacy Day:
Are you a graduate of BU?
If so, what is your year of graduation?
Because we must pay for all lunches we have committed to,please let us know if you
Plan to eat lunch
Plan to do another activity on my own at lunchtime
Do you have any dietary restrictions
Have you attended previous BU Advocacy days?
Planned year of graduation
If you are participating as a representative from Athletics, what is your sport?
What is your major?
Which school are you attending? Please select one :-
Decker
SOM
School of Education
CCPA
Graduate School
Watson
What is your legislative districts and who are your legislators?(if known)
If you are uncertain of who your legislators are or your legislative district, give us your full HOME address(where you vote!) including your 9-digit zip code so that we can try to ascertain this information and match up with your own legislators:
Address
City
ZIP code
