Thank you for registering for the Grassroots Campaign Meeting on 24 March!

Name

Email*

Your story*

Phone

I'm happy for you to share my story through social media and other campaign communications with only my first name and state

I'm happy for you to share my story through social media and other campaign communications with only my first name and state

(We're always looking for powerful stories to amplify by sharing them through Raise the Rate for Good communications and advocacy. This could include Facebook, Twitter, the website, political briefings and other publications. To protect your privacy, we will ONLY use your first name and state/territory.)

I would be willing to talk to journalists about my story

I would be willing to talk to journalists about my story

(If we receive a request from a journalist to talk to someone directly affected, we would contact you to discuss details. We will NEVER share your details with a journalist without your express permission.)

I'd be willing to talk to the media about my experiences with (select all that apply):

(Select all the situations that apply to you that you'd be willing to discuss with a journalist. This will help us match you with a journalist's request for a specific story.)

I live in an area best described as:

Email

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Thanks for registering!

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