Texas Orthopaedic Association Key Contact SurveyTexas Orthopaedic Association Key Contact Survey

Questions 1 - 4 can be answered by looking under the "My Account" or "Legislative" Menus and then selecting "TX District Finder" at the TOA website.

1. Name of your State or U.S. Senator:

Name of your State or U.S. Senator:

2. District Number of your State Senator:

District Number of your State Senator:

3. Name of your Texas or U.S. Representative:

Name of your Texas or U.S. Representative:

4. District Number of your Representative:

District Number of your Representative:

5. A key contact program is a successful method of keeping legislators informed of important TOA political issues. Do you know any legislators (on the state or national level) personally?

A key contact program is a successful method of keeping legislators informed of important TOA political issues. Do you know any legislators (on the state or national level) personally? Yes

6. I know Senator ________________________ well enough to contact personally.

I know Senator ________________________ well enough to contact personally.

7. In regards to the previous question, please answer the following

In regards to the previous question, please answer the following I contributed to his/her campaign

I worked actively in his/her campaign

I am his/her personal physician

I am willing to serve as a Key Contact for this legislator.

None of the above

Other reasons you know this legislator…please explain:

8. I know Representative __________________ well enough to contact personally.

I know Representative __________________ well enough to contact personally.

9. In regards to the previous question, please answer the following

In regards to the previous question, please answer the following I contributed to his/her campaign

I worked actively in his/her campaign

I am his/her personal physician

I am willing to serve as a Key Contact for this legislator.

None of the above

Other reasons you know this legislator…please explain:

10. I don’t know any Texas legislators but I would be willing to cultivate a relationship (i.e. letters, phone calls, etc.)

I don’t know any Texas legislators but I would be willing to cultivate a relationship (i.e. letters, phone calls, etc.) Yes

11. Attending a National Orthopaedic Leadership Conference (Spring in Washington, DC) would be of interest to me. Please keep me in mind.

Attending a National Orthopaedic Leadership Conference (Spring in Washington, DC) would be of interest to me. Please keep me in mind. Yes

Texas Orthopaedic Association Key Contact Survey

1. Key Contact Survey