2024 Capitol Action Day Sponsorship Registration

Thank you for sponsoring the 2024 Capitol Action Day. Please ensure your information is filled out correctly. You will receive a confirmation email after you complete your registration.

Sponsorship Registration

Contact First Name *

Contact Last Name *

Title

If no employer, please write N/A

School/Organization Name *

Street Address *

City *

State *

Country *

Zip Code *

Contact Phone *

Contact Email *

If you have a discount code, enter it here

Sponsorship *

Social Work Friend - $ 500.00

Social Work Supporter - $ 1,000.00

Social Work Advocate - $ 2,000.00

Social Work Mobilizer (T-Shirt) - $ 2,500.00

Social Work Champion (Bag) - $ 5,000.00

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

NASW – New York State Chapter is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed social workers: Provider ID #0014. NASW – New York State Chapter is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists. #MFT-0037. NASW – New York State Chapter is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors. #MHC-0053.