Prescription Drug Affordability Resolution
Please read the resolution and then fill out the form at the bottom and press "Submit" to endorse the Prescription Drug Affordability Resolution on behalf of your organization.

View some of our coalition partners at: http://healthcareforall.com/wp-content/uploads/2018/02/Coalition-Logo-Flier-Feb-13.pdf

Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Organization *
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 on behalf of your Organization.
Name of Representative of the Organization *
Your answer
Title *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms