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MS Action Day 2013 - Jefferson City - Feb. 19-20

 

Please note:  You must complete this survey separately for each person attending MS Action Day.  If you are attending as a couple, please complete the survey twice, so that we will have the correct meal and hotel preferences.

General Information

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Emergency Contact Information

Please provide a contact we may call on in the unlikely event of an emergency.

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Lodging

The National MS Society will cover the cost of the ambassador's hotel room and provide dinner on the 19th and breakfast and lunch on the 20th. Travel, parking, and any additional expenses will be each individual's responsibility.

Please be sure to complete this form separately for each person attending MS Action Day, to ensure that all guests receive their desired meal choice, hotel accomodations, and info packet.

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  If you would like the National MS Society to book your room, please provide the following information.
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Question - Required - Which of the following accommodations do you require? Please choose all that apply.

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Meal Preferences

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Legislative Relationships

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Biography

To help our ambassadors get to know each other, we’d like to provide you with a bit of information about each other in advance of the event.  Please answer the following questions to be included in our Legislative Ambassador directory.

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Make a Personal Donation

Legislative Ambassadors are invited to make a contribution to the MS Society to offset the costs of this program.  To be credited appropriately, donations should be sent to the National MS Society, 1867 Lackland Hill Pkwy, St. Louis, MO, 63146.  Please write “Missouri MS Action Day” on the memo line.

You may also choose to make a donation online.

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