Health Policy New Member Questionnaire
Name *
Email *
Phone number *
Address (practice or home - your choice) *
Years as a Midwife *
Where do you practice? *
Who are your state Senate and Assembly Reps? And what are your district numbers? Include for both your residence and place of work if they are different. (find here: http://findyourrep.legislature.ca.gov/) *
Are you able to make the HP committee and work group meetings on Tuesday nights from 8-9, once or twice a month?
If not able to make the meetings, would you still be interested in being on the Health Policy Workgroup and taking up discrete yet critical tasks when we need the help?
Do you have any policy, advocacy or legislative background or training?
Do you have any relationships with relevant orgs, legislators or funders?
Anything else you would like us to know?
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