Healthcare Reform Support Letter to the President
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1. Default Section

Thank you for signing onto this support letter! Please respond to all questions to have your organization's name included and double-check spelling to ensure accurate information is reported. If you are NOT associated with an organization but would like to sign on to the letter, you may include your first and last name for Question #1. Having trouble? Please email mohiniv@thenationalcouncil.org with the same information.

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1. Name of Your Organization (or Your Full Name if NOT Associated with an Organization):

Name of Your Organization (or Your Full Name if NOT Associated with an Organization):

*
2. City:

City:

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3. State Abbreviation (e.g. AK, MA):

State Abbreviation (e.g. AK, MA):

*
4. Your email address (to send you a final copy of the letter):

Your email address (to send you a final copy of the letter):

Healthcare Reform Support Letter to the PresidentExit this survey

1. Default Section

*1. Name of Your Organization (or Your Full Name if NOT Associated with an Organization):

*2. City:

*3. State Abbreviation (e.g. AK, MA):

*4. Your email address (to send you a final copy of the letter):

Healthcare Reform Support Letter to the President
Exit this survey

*
1. Name of Your Organization (or Your Full Name if NOT Associated with an Organization):

*
2. City:

*
3. State Abbreviation (e.g. AK, MA):

*
4. Your email address (to send you a final copy of the letter):