Optional Member Code

Name of business*

Position of business representative (owner, manager, etc.)*

First Name*

Last Name*

Email*

Street*

City*

State/Province*

Zip/Postal Code*

Phone

Are you already involved with a campaign in your area?*

Are you affiliated with any of the following business associations?

I support earned sick days laws

I support paid family and medical leave

I would like to learn more about earned sick days and/or paid leave.

Please enter any questions or comments below.