JDCA 2022 Week of Action Speaker Interest Form

Thank you for your interest in participating in JDCA's annual Week of Action! Please fill out this form to indicate your interest and availability for a speaking role in our meetings with Members of Congress.

NOTE: We cannot promise that everyone will be assigned speaking roles, but will do our best to include interested respondents in roles that are available.

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Contact Information

First Name Last Name

Street Address (Optional)

Postal Code City State/Province

Email Home Phone (Optional) Mobile Phone (Optional)

Remember me so that I can use FastAction next time.

(Optional)

Speaker interest

What state are you from?

What is your district (Optional)

Which Congressional meetings are you available to speak at? (Please only select meetings from your state)

Do you have additional availability on May 11th and 12th for other Congressional meetings? (Optional)

YES NO

Do you have a topic preference? (Optional)

Combatting antisemitism and right wing extremism Foreign Policy: US-Israel Relationship, preventing a nuclear Iran, and support for Ukraine Defending Democracy: Voting rights and election subversion