STAT Team Info Collection

AMS is developing a grassroots working group called the STAT Team, and the goal of this group is to mobilize doctors for the upcoming legislative session that begins in January. This session will most likely be the hardest one AMS has ever experienced and we need doctors involved at the grassroots level who can share our message with peers and legislators.

The STAT Team is looking for physicians, residents, and students who want to get involved so that the House of Medicine will be successful.

First, tell us about yourself:

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Email *

example@example.com

I am a... *

Physician Fellow Resident Student

Who do you know?

State Senator State Representative

List the names of the State Senators or State Representatives you know.

How would you categorize your relationship? I am a...(check all that apply)

Personal friend Personal acquaintance Consultant Financial donor Campaign advisor

Do you know anyone else in the state legislature that you would like to tell us about?

List the names AND emails of other physicians who may want to be involved.

AMS Stat Team