Organizational Endorsements for the Improving Medicare Coverage Act (Rep. Pramila Jayapal)

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We are NOT accepting individual endorsements. Please only fill out this form if you have the authority to add your organization as an endorsing organization.

Name of Organization *

Exactly as you would like it to appear

Staff Contact Name (First & Last) *

Staff Contact E-mail *

Please choose what best describes your organization *

International

National

State/Local

For state/local organizations, in which state is your organization located? *

e.g. WA, IL, etc.

Do you have the authority to list your organization as endorsing? *

Please note that we are NOT accepting individual endorsements. Please only fill out this form if you have the authority to endorse for your organization.

Yes

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