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Contact Information

Prefix (Optional) First Name Last Name Suffix (Optional)

Street Address (Optional) Address Line 2 (Optional)

Postal Code City (Optional) State/Province (Optional)

Email Home Phone (Optional)

Mobile Phone (Optional)

Twitter Handle (Optional) Facebook Profile URL (Optional)

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Issues You Care About

Please select the check box next to each of the following options if you agree with the statement. New Futures may reach out to you about that issue or priority in the future.

I support lowering prescription drug costs.

I am concerned about high rates of youth vaping.

I support raising the age to purchase tobacco products to 21.

I support policies that address early childhood issues and improve outcomes for our youngest NH residents.

I want to expand access to substance use and mental health treatment in NH.

I want to advocate for substance misuse prevention in NH.

I want to advocate for those in recovery from substance use disorder in NH.

I believe children and youth should have access to community based mental health services.

I support policies that will remove barriers to participating in the legislative process (i.e. being able to testify remotely via video conference or call).

I support increasing access to healthy foods for children and families.

I want to advocate for families in which a grandparent has taken on the responsibilities of parenting a grandchild.

I believe that all families in NH deserve access to affordable, quality child care.

I support expanding resources for a network of family resource centers in NH.

I believe home visiting services should be expanded for NH families.

I would like to work on improving services and expanding access for people with disabilities in NH.

I support policies that improve the health and wellness of NH's older adults.

I support policies that expand access to oral health care in NH.

I support policies that improve NH's mental health system.

I support expanded Medicaid in NH.

I care about equity in access to health care services.

I support policies that improve the health and wellness of those involved in the NH corrections system.

I care about access to women's reproductive health services.

I oppose the commercialization of marijuana in NH.

I am concerned about a lack of affordable housing for people in recovery from SUD.

I want to work to support NH's health care workforce.

About You

If there is a question you do not have an answer to, or you do not feel comfortable answering, please feel free to leave the question blank. The information you provide in this form will only be available to members of the New Futures staff. If you would like to discuss a question on this form, please contact kfoster@new-futures.org.

Learn more

Which (if any) of the above issues would you like to learn more about? (Optional)

Advocacy preferences and interests

Are you interested in sharing your story about any of the following topics? (Optional)
Are you interested in sharing your story about any of the following topics? is required.

Cost of prescription drugs

Access to children and family supports

Children's mental health

Seeking substance use treatment/recovery services in NH

Seeking mental health services in NH

Experiences with the health care system in NH

Other Other

How would you like to advocate? (Optional)
How would you like to advocate? is required.

Attend a New Futures advocacy training

I want to talk about how I can advocate with a community engagement coordinator.

Call my legislator

Meet one-on-one with a legislator

Testify at a hearing or committee in Concord

Write or sign on to a letter to the editor

Write a blog post for the New Futures website

Use social media to inform others

Sign a petition

Attend a press conference

Attend a rally, legislative event, or other event

Host a legislative event in your area

Call in to a NH radio show and ask a question

Other Other

Please check any of the following statements that apply to you: (Optional)
Please check any of the following statements that apply to you: is required.

I am a certified recovery support worker in NH.

I am a licensed alcohol and drug counselor in NH.

I am a student assistance program counselor in NH.

I am a certified prevention specialist in NH.

I am a college student in NH.

I am a young adult in NH.

I am an educator.

I am a health care provider in NH.

I am a law enforcement official in NH.

I am a business professional in NH.

I am a part of a faith community in NH.

I have served in the military.

I am a leader in my community.

How do you prefer to be contacted? Select all that apply. (Optional)
How do you prefer to be contacted? Select all that apply. is required.

Mobile phone

Text message

Home phone

Personal email

Work email

Other Other

Where You Work

What organization or business do you work for? (Optional)

What's your occupation? (Optional)

What other organizations do you advocate or volunteer with? (Optional)

What's your work zip code? (Optional)

What's your work phone number? (Optional)

What's your work email address? (Optional)

Demographic Information

Preferred pronouns (Optional)

Preferred language (Optional)

Gender identity (Optional)

Race (Optional)

Ethnicity (Optional)

Other information (Optional)

Sexual orientation (Optional)

Age (Optional)

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Thank you for advocating for the health and wellness of New Hampshire residents.

The information you provide in this form will only be available to members of the New Futures staff. If there is a question you do not have an answer to, or you do not feel comfortable answering, please feel free to leave the question blank.