Add My Signature!

By filling out this form and submitting it to ICTE, your name will be added as an electronic signatory to the ICTE Declaration.
*Required Fields

**Requested for verification purposes only.

Representation: I am a member of (the/an): ClergyLaityOrganizationIndividual
Congregation/Affiliation:
Title:(Mr., Ms., Rabbi, Rev...)
*First Name:
*Last Name:
*Email:
**Phone:
Address:
City:
State: (Use 2 letter Code)
Zip:
Message:
Yes, I would be willing to testify on HB 1722
Yes, You have my permission to display my name as a supporter on the ICTE website
Yes, I would like more information, please contact me via: EmailPhone