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