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* 1. Name

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* 2. Company

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* 3. Email Address

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* 4. Did you attend the 2018 HCAOA AZ lobby day?

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* 5. Are you willing to assist in a letter writing campaign as a follow up to the 2018 lobby day?

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* 6. Would you be interested in helping to plan the 2019 AZ lobby day?

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* 7. Would you be willing to donate money to HCAOA to help pay for a consulting firm such as Goodman Schwartz to help us organize the 2019 AZ lobby day?

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* 8. Do you have any interest in attending a lobby day in the Spring of 2019?

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* 9. What legislative goals do you feel the chapter should pursue in future lobby days?

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