JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
OPPOSE HB1222 TRACKING
Please answer the following questions so we can keep up with the efforts we have made. This will also be beneficial if and when issues like this arise in the future - I have no doubt that they will.
Name:
Your answer
Job Title:
Your answer
Email:
Your answer
Phone Number:
Your answer
Place of Employment:
Your answer
Is your physician(s) aware of HB1222?
Yes
No
Other:
Clear selection
Who have you called / spoken with in the legislature to oppose HB1222?
Your answer
If you have anything else you'd like to add, please feel free to do so here.
Your answer
Submit
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
