Sign On - Letter Supporting FDA finalization of rules preventing the use of shock devices on people with disabilities

Please complete the form below if you represent an organization that wants to sign on to the letter to HHS, the FDA and the OMB. You can complete the form as an individual as well if you would like to be kept informed on this issue.

We are accepting only organizations as signers. Your organization can be local, state, regional or national. Only one person per organization needs to reply.

We will list only organizations as signers but we will keep all respondents apprised of any progress or future action.

We plan to send the letter on Thursday, May 26th. To be included, all responses must be received by Wednesday, May 25th, close of business.

Thank You!

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* 1. First and Last Name

First

Last

Suffix, degree, etc. (if applicable, or leave blank)

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* 2. Your email address (enter carefully):

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* 3. Name of Organization. Do not use acronym unless your org. uses only the acronym as its name

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* 4. I am giving permission for the organization listed above to be a signer of the letter to HHS, the FDA and the OMB

Yes

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* 5. City and State in which organization is located. Please use two letter state code. Add Country if non-US.

City

Two Letter State Code

Country if non-US only

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* 1. First and Last Name

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* 2. Your email address (enter carefully):

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* 3. Name of Organization. Do not use acronym unless your org. uses only the acronym as its name

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* 4. I am giving permission for the organization listed above to be a signer of the letter to HHS, the FDA and the OMB

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* 5. City and State in which organization is located. Please use two letter state code. Add Country if non-US.

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* 6. Any additional comments: