Anti-Mandatory Mail Order Lobby Day Registration
Please fill out this RSVP form to lobby for the right to use a local pharmacy or mail order for your prescriptions in New York State on April 28, 2015.
Please provide your full name
Please provide the best way to contact you. (Phone and/or email)
Briefly explain your interest in participating in the anti-mandatory mail order pharmacy lobby day
I am personally affected
I have clients who are affected
I have friends or family who are affected
I am interested in one of the following areas of focus
Another condition not listed here
Please provide the name of your New York State Senator
Find your State Senator here:
Please provide the name of your New York State Assembly Member
Find your State Assembly Member here:
Mode of transportation to and from Albany, NY
Please let us know how you plan to travel to and from Albany
I am joining the bus from NYC.
I am traveling independently. (Limited number of $25 Gas Cards Available)
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