Key Contact Form

Key Contact Form

Submitted by MSumma on Tue, 03/11/2008 - 05:11.

CAFP needs family physicians who are willing to get involved as key contacts on legislative issues affecting health care. As a key contact you will inform your particular state legislators or US Congressional representatives about critical health care issues California.

To become a Key Contact, please fill out the form below, and we will contact you to let you know how you can be involved.

For more information on our Key Contacts program, please contact Adam Francis at (415) 345-8667.

Date: *

First Name: *

Last Name: *

Home Address: *

Home City: *

Home Zip Code: *

Work Address: *

Work City: *

Work Zip Code: *

Preferred Phone: *

Fax: *

Email: *

Your Legislator(s) or Congressional representatives, if known. Please briefly note relationship (e.g., constituent, friend)::

Please list any areas of interest or expertise (e.g. women's health, Medi-Cal, privileging):

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