I will attend/testify at/support the Public Hearing

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PPF and allies won a public hearing on ACA premium increases from the PA Department of Insurance! This hearing is the first of its kind. The hearing will take place on Wednesday, July 27th at 9:30 am in Harrisburg at the Keystone Building, 400 North Street. Thank you for filling out this form!

Name *

E-mail *

Phone number *

Location *

I will (check all that apply) *

Attend

Invite others to attend

Testify - Rising premiums have impacted me and my family

Identify others to testify - please follow up with me

Send organizational representatives to the hearing

Prepare testimony that can be delivered to or read at the hearing

Make a monetary contribution so that PPF can send people to the hearing

Support the hearing by helping to get press and/or using social media

Drive others to the hearing

Host a watching party of the live stream

Other:

Required

I need (check all that apply)

A ride to the hearing

Childcare for the hearing

Support preparing my testimony

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms