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* 1. What is your contact information?

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* 2. Which office are you running for?

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* 3. Please describe your reason for requesting an endorsement from UAFP FamMedPAC. How will your election support family medicine?

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* 4. What is your position on the Affordable Care Act?

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* 5. What is your position on Medicaid Expansion?

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* 6. What kind of endorsement are you seeking?

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