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Sign up and join the Women's Health PAC, to unite our collective financial and bipartisan political power to advance women's health.
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First Name
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Middle Name
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Last Name
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Pronouns
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Credentials
(e.g., MD, PhD, Esq.)
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Personal Email
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Cell Number
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City
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State
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Zipcode
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Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Mixed (two or more)
Other
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Age range
*
<35
35-44
45-54
55-64
65+
Employer
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Your answer
What areas of Women’s Health interest you?*
(multiple)
Adverse Drug Reactions - therapeutic development for women, drug safety., clinical trial representation, etc.
Aging Health - Osteoarthritis, Osteoporosis, Muscular Atrophy, Quality of Life, etc.
Autoimmune Health - Lupus, Multiple Sclerosis, Rheumatoid Arthritis, Thyroid Disorders, etc.
Brain Health - Alzheimer's, TBI, Migraines, Memory, Cognitive Decline, etc.
Cancer - Breast, Cervical, Colon, Lung, Ovarian, Rare Cancers, etc.
Gynecological & Ovarian Health - Fertility, Menopause, Endometriosis/Fibroids/PCOS/Adenomyosis, Pelvic Pain, HPV & STIs, Incontinence, Prolapse, UTIs, etc.
Heart Health - Cardiovascular Disease, Diabetes, Stroke, Obesity, Hypertension, etc.
Maternal and Postpartum Health.
Mental Health.
Wellness - Sleep, Maternity Leave, Workplace Policy, Stress, etc.
Other:
How would you like to get involved with the Women’s Health PAC?*
(multiple)
*
Founders Circle – provide strategic insights for the PAC leadership, $2500 annual contribution.
Fundraising Committee – raise capital to fund PAC initiatives, candidates and operations.
Political Committee – track political campaigns and identify candidates to endorse.
Marketing/Communications Committee – guide marketing campaigns and media engagement.
Strategic Partnerships Committee – build lists and relationships aligning with the PAC’s mission.
Stay in the know - receive emails on the PAC’s events and activities.
Required
Check below to
join other women’s health professionals in your city to plan events and serve in leadership roles.
(multiple)
Boston
Los Angeles
New York
San Francisco
Washington, DC
Chicago
Dallas
Denver
Honolulu
Houston
Miami
Other:
How are you currently involved in Women’s Health?
(multiple)
Investor
C-Suite Executive
Provider
Payer/Health System
Policy
Other:
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