Legislative Advocacy

LDC Application

Complete the following information and submit your online application. Or, if you prefer, download and print the following form and return by first-class mail.

LDC Application (.pdf format; Adobe Acrobat Reader required)

As a LDC, I understand I will be asked to:

establish and mobilize a network of local nurses in the assigned legislative district;
act as liaison between NYSNA and the assigned legislator;
educate and lobby legislators regarding NYSNA's position on legislation;
interview candidates in assigned district;
encourage nurses to become involved in campaigns of NYSNA-PAC endorsed candidates;
assist with fundraising for NYSNA-PAC.

	Information (*required)
Name*
Credentials
Address*
City, State, Zip*
Phone*	(Home)
Fax
e-mail*
I.D. Number*	Member ID# or Soc. Sec. #
Are you represented for collective bargaining by NYSNA?	Yes No
Employer
Employer Address
City, State, Zip
Business Phone
Business Fax
Business e-mail
Contact	Can you accept phone calls at work? Yes No What hours are you available at work?
Membership	I am a current NYSNA Member Yes No I am a NYSNA District Member Yes (District # ) No
Voting Status	I am registered to vote at my current address Yes No
Representation	I live in Senate District # , represented by Senator I live in Assembly District # , represented by Assemblymember
LDC Network Position	I am interested in being a coordinator for: Senate Assembly District #
Lobbying/Political Experience