Get Covered 2017 Organizational Pledge
Everyone's health is important. That's why we want to make sure you take advantage of the ACA Open Enrollment period (November 1 - December 15) and GET COVERED! With the shorter federal Healthcare.gov open enrollment period, cuts to navigator funding and advertising, it is now more important than ever to spread the word about the marketplace. Take the pledge with us and spread the word!

This pledge campaign is hosted by the Asian & Pacific Islander American Health Forum.

Name of Organization *
Your answer
Contact Person's Name *
Your answer
Email *
Your answer
Twitter *
Your answer
Facebook *
Your answer
Instagram *
Your answer
Take the pledge! *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms