MCAAP Legislative Policy and Request for Endorsement Form (2)

Policy and Endorsement Form

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* 1. Name of Requestor

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

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

Yes

No

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* 4. What organization are you representing?

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* 5. What is your deadline?

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

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