Every Person Counts!

Every Person Counts!

Engage, Educate, Empower . . . and Tell Us! Make sure we're counting your actions by filling out the form below!

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I am a: * Doctor Medical Student Other Supporter

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I did these on the day/week of:

INFORMAL EDUCATION:
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PHYSICIAN / MED STUDENT PRESENTATION:
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PUBLIC PRESENTATION:
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FLIERS:
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MEDIA:
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Has it been published/Aired?
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DECLARATIONS:
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Input the names and mail them in. Or you can just mail them in and we'll enter them for you! (Doctors for America, 2nd Floor, 1333 H St NW, Washington, DC 20005)