RX Medicare for All
Use this form to indicate your willingness to organize an action during the August congressional recess. You do not have have to have all the details before filling out this form. See www.pnhp.org/augustrecess for a running list of actions being planned.

Please contact organizer@pnhp.org with any questions.

Your Name (first and last)
Your answer
Your email
Your answer
Your phone number
We will not share your number
Your answer
What is your city?
Your answer
What is your state?
Your answer
What kind of event do you hope to plan?
Required
Link to facebook event for your action
(If you have one)
Your answer
Please share a little more information about your event:
Please share date/time/location (if you have them), along with any co-sponsors of the event and a brief description.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms