2014 Kidney Disease and Awareness Education Week Scheduled Visit Information

1. KDAE Week Scheduled Visit Information

ANNA wants to know what Senator or Representative will be visiting your unit and when. Please help us to keep track of KDAE Week visits! ANNA Federal Health Policy Associates will follow up with the Congressional office with any additional information and reinforce the message(s) you delivered.

Thank you!

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* 1. Personal Information:

Name:

City/State:

Phone:

E-mail:

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* 2. KDAE Week Visit Information

Dialysis Unit:

Elected Official Visiting:

Date Scheduled:

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* 1. Personal Information:

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* 2. KDAE Week Visit Information

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* 3. Please list any questions or comments concerning the upcoming Scheduled visit.