Health Equity and Diversity Advocacy Group

Question Title

1. First Name
(Required.)

Question Title

2. Last Name (Required.)

Question Title

3. Membership Number (Required.)

Question Title

4. E-mail Address (Required.)

Question Title

5. Phone Number (Required.)

Question Title

6. City (Required.)

Question Title

7. State (Required.)

Question Title

8. Do you have a relationship with your member of congress? (Required.)

Yes

Question Title

9. If yes, which members?

Question Title

10. In which of the following activities are you interested in participating? (check all that apply) (Required.)

1. Complete action alerts

2. Join monthly call to share progress and updates

3. Send personalized letter of communication to your members of Congress

4. Help place a letter to the editor in your community newspaper

5. Participate in meetings with your members of Congress (via video, telephone or in person)

6. Secure support from other organizations for health equity and diversity initiatives

7. Author articles and documents that can be used for advocacy

8. Review documents and resources for advocacy

9. Attend ANDPAC events

10. Support ANDPAC with a contribution of any amount

11. Other, please specify (open text box)

Health Equity and Diversity Advocacy Group

Question Title

* 1. First Name (Required.)

Question Title

* 2. Last Name (Required.)

Question Title

* 3. Membership Number (Required.)

Question Title

* 4. E-mail Address (Required.)

Question Title

* 5. Phone Number (Required.)

Question Title

* 6. City (Required.)

Question Title

* 7. State (Required.)

Question Title

* 8. Do you have a relationship with your member of congress? (Required.)

Question Title

* 9. If yes, which members?

Question Title

* 10. In which of the following activities are you interested in participating? (check all that apply) (Required.)

1. First Name
(Required.)

2. Last Name (Required.)

3. Membership Number (Required.)

4. E-mail Address (Required.)

5. Phone Number (Required.)

6. City (Required.)

7. State (Required.)

8. Do you have a relationship with your member of congress? (Required.)

9. If yes, which members?

10. In which of the following activities are you interested in participating? (check all that apply) (Required.)