Tally for Grassroots letter writing to support S. 109

This survey collects the names of NCCCP members who have submitted letters to California Senators Feinstein and Harris asking them to support S. 109 using the CSHP letter writing function or called the Senators' offices asking them to support S. 109.

The letter writing function can be found at: found at http://cshp.org/TakeAction

Membership in CSHP is not required to use this function.

The Senators' office phone numbers are:

Senator Feinstein (415) 393-0707

Senator Harris (559) 497-5109

If you have submitted a letter supporting S. 109 to our California Senators using CSHP's letter writing function, or called one or both Senators, please provide the following information.

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* 1. Name

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* 2. Status in NCCCP

Pharmacist member, not a resident

Pharmacist, not a resident, but not a member of NCCCP

Resident member

Resident, but not a member of NCCCP

Student member

Student, but not a member of NCCCP

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* 3. I participated in the following Grassroots activities to support S. 109 and HR 592:

I used the CSHP letter writing function to send a message of support to my Senators and House Representatives

I called Senator Feinstein and asked her to support S. 109

I called Senator Harris and asked her to support S. 109

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* 4. Please enter date that letter was sent (approximate if needed)

Date

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* 5. Please enter date that you called Senator Feinstein (approximate if needed)

Date

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* 6. Please enter date that you called Senator Harris (approximate if needed)

Date

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* 7. I give NCCCP permission to provide my name to the NCCCP Board and CSHP for tally purposes.

Yes

No, only report my participation as a tallied number

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* 8. I give NCCCP permission to report my name to the NCCCP membership for tally purposes and to encourage others to participate in the Grassroots effort.

Yes

No, only report my participation as a tallied number

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* 9. I would like to serve as a volunteer on the NCCCP Grassroots Committee to support S.109 and HR 592.

Yes, please add me to the list of people willing to serve on the Grassroots Committee for S. 109 and contact me about what I can do to help!

No, thank you. I've participated as much as I would like at this point.

Other (please specify)

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* 10. If you have volunteered to participate with the NCCCP Grassroots Committee to support S. 109, please provide your contact information:

Name

Email Address

Phone Number