Copy of MCAAP Legislative Policy and Request for Endorsement Form (3)

Policy and Endorsement Form

Question Title

* 1. Name of Requestor

Question Title

* 2. Contact information (email and phone number):

Question Title

* 3. Are you a member of the Massachusetts Chapter of the American Academy of Pediatrics?

Yes

No

Question Title

* 4. What organization are you representing?

Question Title

* 5. What is your deadline?

Question Title

* 6. If you are requesting support for a bill, what is the bill name and number?

Question Title

* 7. What type of support are you requesting (e.g. letter of support, organizational sign-on letter)?

Question Title

* 8. Do you have any background information (e.g. fact sheet)? If so, upload or cut-and-paste it here and/or provide a link.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.