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Rise to Action and Survivors' Lobby Day Registration Form

Registration is required to attend. Please complete this form and submit no later than March 7th for inclusion in the Survivors' Lobby Day (March 21st RSVP deadline for participants attending only the Saturday/Sunday conference portion).

Registration fee: $30 for all participants attending the conference portion of Rise to Action, including family members and friends. Your fee includes complimentary meals and snack breaks during the conference, as well as an RTA t-shirt! Please note: There is no fee for participation in the Survivors' Lobby Day. Need-based scholarships to cover the cost of the registration fee are available upon request. Please email us at rta-dc@childrenscause.org to arrange financial assistance.

Registration Information

* Required Field

* Attending the following:
Rise to Action Conference, April 12-13th
Survivors' Lobby Day, Monday April 14th

Survivor Information









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Additional Information

Please indicate your preference (1-6, 1 being the highest) for breakout sessions you would like to attend.






If you will be traveling to the DC Metro area, would you like us to provide you with information about overnight lodging? Yes No

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CFC No. 71422