Prescription Drug Affordability Resolution
Please fill out this form to sign the Prescription Drug Affordability Resolution on behalf of your organization.

To view the text of the resolution, follow this link: http://healthcareforall.com/wp-content/uploads/2017/10/2018-Prescription-Drug-Affordability-Resolution-2.pdf

To view a list of endorsers, go to: http://healthcareforall.com/wp-content/uploads/2018/01/2018-Rx-Statewide-Regional-Coalition-5.pdf

Organization *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number (office) *
Your answer
Phone Number (cell)
Your answer
Email Address *
Your answer
By typing your name below, you are electronically signing this resolution.
Name of Representative of the Organization *
Your answer
Date *
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