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Health Equity and Diversity Advocacy Group
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Membership Number
(Required.)
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4.
E-mail Address
(Required.)
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5.
Phone Number
(Required.)
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6.
City
(Required.)
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7.
State
(Required.)
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8.
Do you have a relationship with your member of congress?
(Required.)
Yes
No
9.
If yes, which members?
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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)
Current Progress,
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