Thank you for your interest in the CAR's Parliamentary Outreach Program. In completing this survey, your name will be added to the list of CAR advocacy representatives across the country. You must be in a member of good standing to participate in the program. Once approved, you will be contacted by a CAR staff member who will share regular health related policy updates and a resource toolkit to assist you in your grass roots outreach efforts. 

Thank you for volunteering to represent your profession.

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* 1. Please enter your first and last name. 

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* 2. Please select your location of practice from the list below.

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* 3. Please indicate your professional status

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* 4. Please indicate your place of work (academic institution for medical students and residents).

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* 5. Please indicate your radiology subspecialty.

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* 6. Do you have advocacy experience?

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* 7. Have you met with your MP before?

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* 8. Are you active on social media?

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* 9. Do you have 5 hours per month to allocate to advocacy related efforts?

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