Medicare for All Petition
I urge my state and federal elected officials to create an expanded and improved Medicare for All healthcare system. Petition will be delivered by Kim for Senate 2018.
First Name *
Your answer
Last Name *
Your answer
Email
Your answer
Phone Number
Your answer
Street Address (e.g. 123 Liberty Lane) *
Your answer
Zip Code *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service