#ME Action Georgia Census

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The purpose of this census is to help coordinate our advocacy efforts when contacting our state and federal representatives. Your information is private and can only be viewed by the four members of the #MEAction GA Census Committee. These members are: Liz Burlingame, Betsy Friedrich, Chris Brooks and Tracy Miller. If you have any questions regarding how your information may be used, do not hesitate to contact #MEActionGA at georgia@meaction.net

Email *

First Name *

Last Name *

Street Address *

City

State

Zip Code *

Are you a patient or healthy ally? *

Patient

Healthy Ally

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