Storm The Hill With The Maryland Delegation
Join your colleagues and Maryland Optometric Association leadership for advocacy in Washington DC. AOA on Capitol Hill will be held on April 9, 2019. Participation is open to all doctors and optometry students.

Please fill out all required fields so MOA staff can set up meetings on your behalf based on your and your legislators' availability. When your meeting times have been determined, you will receive confirmation along with meeting details and relevant advocacy materials. (NOTE: MOA takes member privacy very seriously - any personal information provided will remain confidential and will only be used by the MOA for advocacy purposes).
Email address *
Name *
Your answer
Voting Address *
Your answer
Home or Cell Phone Number *
Your answer
Practice Name (If Student - Put N/A) *
Your answer
Practice Address (If Student - Put N/A) *
Your answer
Preferred Method of Contact *
Please choose the time(s) of your availability *
Please direct all questions related to MOA legislative efforts to Jennifer Cohen at or (410) 949-7006
Never submit passwords through Google Forms.
This form was created inside of Maryland Optometric Association. Report Abuse - Terms of Service