Information and Education Days 2023 Registration Form

Name *

First Last

Please provide your pronouns.

Note: pronouns will be printed on your name badge.

Voting Address *

This will be used used to match you with your state Assembly Member and Senator. In most cases, this will be your home address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email *

Cell Phone: *

This will be used in a text group with those participating in the same legislative meetings.

What is your Tobacco Control Project or Affiliation? *

CTCP-funded Project

Coalition Member

Contractor or Consultant

Voluntary Health Organization

Please spell out the Organization Name *

Consent *

By registering, I agree to attend legislative meetings with my Assembly member and my Senator. *

Each legislative meeting requires a Meeting Lead. I agree to serve as the Meeting Lead for my Legislative Meetings? *

Yes

Only if Necessary

Have you developed a relationship with a current state Assembly Member, Senator, or their staff? If so, please indicate which member and your relationship.

Legislative Caucus Meetings: Determining speakers and participants at Caucus meetings is being managed by the caucus leads and space is very limited. With I&E Day being held in-person, only 5-7 people can be present in the Caucus meetings.  Please contact a caucus lead for more information.

Black: Y’Lonn Burris yburris@amplify.love
Latino: Rosendo Iniguez riniguez@healthcollaborative.org
API: Priya Raman praman@appealforhealth.org
LGBTQ+: Astin Williams awilliams@health-access.org
Rural: Amber Morris AMorris@healthcollaborative.org
Environment: Efraim Lopez efraim.lopez@sierraclub.org
Native American Affairs select committee: Ravena Soto ravena.soto@etr.org
Women’s: Kim Homer Vagadori kim@cyanonline.org

Do you have any accommodations requests (e.g. visual or hearing impairment, accessibility needs, language interpretation, etc.). If yes, please detail those needs, and a staff member will be in touch to discuss further.

Do you plan to attend the Monday, May 8 Opening Session? Attendance is strongly recommended, but not required. *

Yes

On Tuesday, May 9, a box lunch will be provided for attendees. Please select which type of lunch you would like: *

Gluten Free

Vegan

Vegetarian

No dietary restrictions

Photos and/or videos may be taken and included on the Tobacco Endgame Center’s website or used for promotional purposes. Do you agree to allow your image to be captured and used? *

Yes

Would you like to be added to the Center’s email list? *

Yes

Hotel Information
Holiday Inn Sacramento Downtown – Arena
300 J Street, Sacramento, CA 95814
Hotel Website
Check-in: May 8
Checkout: May 9

The opening night session and morning gathering session will be held in the hotel’s meeting space.

The hotel is a 15-minute drive from Sacramento International Airport (SMF) and 14 min walk from the California State Capitol.

Price: $95 (state rate) a night when you use the room block. We strongly encourage those staying overnight to book within the room block.

Book Room

Before completing your registration, please note that if your funding does not begin until at least May 1, 2023 (including Competitive Grants 22-10399 and 22-10403) then you cannot book travel or incur costs for travel (e.g. airfare, car rentals) prior to the full execution of your contract and be reimbursed by CTCP. Please contact your CTCP Program Consultant and Procurement Manager with questions.

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