2023 Family Medicine Advocacy Day - April 13, 2023

Question Title

* 1. Name and Home Address

Name and Degrees

Home Address

Home Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Work Address

Clinic/Health System

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 3. Membership Type

Active Member

Resident Member

Student Member

Life Member

Other (please specify)

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* 4. Please list any topics of special interest to you regarding legislation affecting primary care delivery and patient care: