AAPA Key Contact Form

AAPA KEY CONTACT FORM

The goal of AAPA's Key Contact program is to build a national network of PAs who have an existing relationship with a Member of Congress (or who would be willing to build one), and who would be willing to maintain those positive relationships through advocacy on AAPA policy priorities throughout the year.

Please complete this form to indicate your prior experience with advocacy and interest in becoming an AAPA Key Contact.

Thank you for your leadership!

First Name: *

Last Name: *

Email: *

AAPA Member ID *

Home Address *

City *

State *

Zip Code *

Phone:

Who is your representative in the House?

Don't know? Look it up here.

If you have a personal or professional relationship with a member of the U.S. House of Representatives or U.S. Senate, please list their names and your relationship below:

Please check any political activities you've participated in previously.

Met with a federal legislator or their staff

Attended a town hall meeting

Attended a political fundraiser

Participated in political campaign activities ("Get out the vote," distributing leaflets, phone-banking, political rally, voter registration drive, etc.)

Participated in a federal or state lobbying day, including the AAPA Leadership and Advocacy Summit

Ran for political office

Other

If you checked "Other," please explain.

Which of the following activities would you be willing to participate in?

Respond to calls to action by personally calling or writing your Member of Congress

Meet with your legislators in their state/district offices

Meet with your legislators in Washington, DC

Donate to AAPA's political action committee, PA-PAC

Host facility or practice tour

Host or co-host a political event for your legislators

Other Other