Voter Voice Advocacy Engagement Campaign Request

Please provide campaign details below. * Items are required.

State Association
Name of person making the request Name of person making the request First Last
Email
Contact Phone Contact Phone - ### - ### ####
How would you like this campaign to be distributed? (pick one)

How would you like this campaign to be distributed? (pick one) I will email to my members. A plug-in will be provide by ChiroCongress for my use. I want ChiroCongress to email. I will provide an email list of my members that will be utilized for initial distribution this campaign only and will be purged immediately afterwards. I want ChiroCongress to email. I will provide an email list of my members to be utilized for this campaign and subsequent versions of this campaign. I will notify ChiroCongress when the campaign is complete and my emails will be purged afterwards.
What do you want your members to do? (Check all that apply)

What do you want your members to do? (Check all that apply) Write an email Make A Phone Call Send a Tweet
Time Frame to start campaign Time Frame to start campaign / MM / DD YYYY
Time Frame to end campaign Time Frame to end campaign / MM / DD YYYY
Headline (Required) - Example: Contact Your US Congressmen about Proposed Medicare Cuts
Maximum of 50 characters allowed. Currently Entered: 0 characters.
Compose the Body of this Action Alert - What would you like to tell your members about Call to Action? Example: Education about the Bill; Why they should contact their State Representative or Senator; What your ASK is...
Message Recipients - Select the targeted recipients you want your members to contact:

Message Recipients - Select the targeted recipients you want your members to contact: US House of Representatives US Senate US President US Vice President State House State Senate State Governor State Lt. Governor State Attorney General State Secretary of State Other Other

Check all who should receive your message
Message Subject Line for the email your members will be sending
Maximum of 50 characters allowed. Currently Entered: 0 characters.
Call to Action item for Congressional Leader
If you want your members to send and email, which option would you like?

If you want your members to send and email, which option would you like? Your Message + Personal Story (Encourage your advocates to provide their own personal story above the message you provide) Your Message + Guidelines (Guide your advocates in customizing the message you provide) Your Message Only (Provide the message for your advocates and do not ask for personalization) Blank Form + Guidelines (Guide your advocates in writing their own message) Blank Form Only (Provide no assistance to your advocate in composing their own message)
Select Primary Congressional Web Form Issue

US Congress requires an issue be assigned to the email so it can be routed to the correct aides, if necessary.
Message Body Text - Enter the pre-written message that you would like your members to send.

Educate, be concise, and make your ASK. Make sure to thank your congressional leaders for their service and consideration on the matter.
Do you want your members to be able to edit the message text above?

Do you want your members to be able to edit the message text above? Yes No
Enter any instructions or guidance your members need to know if they are allowed to edit the Message Body above
Twitter/Phone (Optional add-ons)

This are additional ways your members can interact with their representatives and senators. To send a Tweet, advocate must have an active Twitter account.
Compose the Twitter message to be sent to targets:
Maximum of 260 characters allowed. Currently Entered: 0 characters.
Talking Points - Use this option if you are having your members "Make a Phone Call"
Campaign Confirmation Information

Enter the information you would like to display on-screen or be sent to your members for participating in your Advocacy Campaign.
Text to display on-screen to your members after they take action.

Default = Thank you for supporting our effort. We appreciate your interest and hope that you will consider helping us again in the future.
Text for Thank You email sent to your members after they take action. Include the name, title and contact information for sender from your organization if you would like it included.

Default = Thank you for supporting our effort. We appreciate your interest and hope that you will consider helping us again in the future.
Would you like your members to be able to share this campaign on social media?

Would you like your members to be able to share this campaign on social media? Yes No

Voter Voice Advocacy Engagement Campaign Request

Voter Voice Advocacy Engagement Campaign Request

Twitter/Phone (Optional add-ons)

Campaign Confirmation Information