Congressional Briefing on Polycystic Ovary Syndrome (PCOS)
The Metabolic Disorder Wreaking Havoc on Public Health
Complete the form below to RSVP - Only 20 Spaces Available
Join PCOS Challenge: The National Polycystic Ovary Syndrome Association for a special Congressional Briefing on PCOS.

Date and Time:
Wednesday, September 27, 2017
1:00-2:30 PM

Location:
122 Cannon House Office Building
Washington, DC 20003

First Name
Your answer
Last Name
Your answer
Email Address
Your answer
Phone
Please use format XXX-XXX-XXXX
Your answer
Organization/Company
If Applicable
Your answer
Address
Your answer
Suite/Apartment/Unit
Your answer
City
Your answer
State
Zip Code
Your answer
Lunch Preference
Are you available and willing to meet with staffers from your Congressional Representatives' offices on September 27th between 10am-5pm?
OPTIONAL - Additional Comments
Your answer
Military Servicewomen
Are you a retired or active duty military servicewoman with PCOS? If so, are you available and willing to speak about your experience with PCOS in the Military during the briefing?
OPTIONAL - Please share with us what you would like your Congressional Representatives to know about your experience with PCOS in the military.
Your answer
Privacy Statement
PCOS Challenge, Inc. is committed to keeping your personal information confidential. We respect your privacy and will not sell, share or rent your information to anyone for any reason.


Submit
Never submit passwords through Google Forms.
This form was created inside of PCOS Challenge, Inc.. Report Abuse - Terms of Service - Additional Terms