Survey - RESOLVE State Captain Application 2023 - RESOLVE: The National Infertility Association

RESOLVE State Captain Application 2023

Thank you for your interest in becoming a State Captain for RESOLVE/ASRM Federal Advocacy Day. Prior to filling out the application, please view the Volunteer Committee Informational Webinar. If you have any additional questions, contact advocacyday@resolve.org.

1. Please fill out the following information:

Field Is Required First Name

Field Is Required Last Name

Employment Information

Field Is Required Employer:

Field Is Required City/Town:

Field Is Required State / Province:

Field Is Required Email:

Field Is Required Phone Number:

Yes, I would like to continue or start receiving email communication from RESOLVE.

2. Field Is Required What is your relationship to infertility?

3. Field Is Required Why do you want to volunteer as a State Captain? (Maximum response 255 chars, approx. 5 rows of text)

4. Field Is Required Have you previously served as a State Captain for Federal Advocacy Day?

5. Field Is Required If answered yes to State Captain question- How many years?

6. Field Is Required Can you commit to the State Captain volunteer timeline from October 2022 to April 2023?

7. Field Is Required Can you commit to attending State Captain training sessions and kickoff webinars?

8. Is there anything else you would like us to know? (Maximum response 255 chars, approx. 5 rows of text)