JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Community Midwife Consumer Advocacy Group in Georgia
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Have you signed up for email alerts on the home page of our website at www.gacpm.org?
*
Yes
No
I am a registered Georgia voter.
*
Yes
No, I need help registering
Do you support licensing Community Midwives in Georgia?
*
Yes
No
Other:
Address or at least City and County
*
Your answer
Who is your Georgia House Representative please check this info at
https://openstates.org/find_your_legislator/
*
Your answer
Who is your local Georgia Senator please check this info at
https://openstates.org/find_your_legislator/
*
Your answer
Are you willing to contact your reps on behalf of GA Midwives?
*
Your answer
I am able to volunteer my services for….
*
Fundraising opportunities
Administrative work
Hosting local meet-ups to invite representatives to interact with constituents
I own a small business that can provide resources (print, goods for sale/auction, etc)
Other:
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
