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Urge Medical Society of Virginia to Oppose Assisted Suicide
Please use this survey to indicate your interest level in advocacy to oppose the legalization of assisted suicide.
1.
Profession
Physician
Physician Assistant
Resident
Fellow
Medical Student
PA Student
2.
Name (First and Last)
3.
Email
4.
Daytime Phone
5.
Mailing Address - City or County
6.
Mailing Address - Street
7.
Mailing Address - State
8.
Mailing Address - Zip
9.
Are you a registered, dues-paying member of the MSV?
Yes
No
No, but tell me how I can join.