AAP-CA Chapter 2 Membership Input Form

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Dear AAP-CA2 member,

We would like to hear from you!

Please share with us any concerns, questions or ideas that the AAP-CA2 board of directors should discuss and address during future meeting. This form is anonymous and confidential. Should you like to be identified and/or receive a call from a board member, staff, or any other chapter representative, there is an opportunity to enter those details after submitting this form.

Thank you for your suggestions and for your support.

Melissa Ruiz, MD, FAAP - Chapter President

County for which I am reporting *

San Luis Obispo

Santa Barbara

Ventura

Kern

Los Angeles

San Bernardino

Riverside

Concerns, questions or ideas to bring up to the board of directors.

Would you like to discuss your concern, question or idea with a chapter representative? (If yes, you will be able to select who will contact you on the next page)

Yes, I would like to discuss further.

No. I am submitting this anonymously (Be sure to click "Submit" on the next page).

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