ACPeds - Open Letter Signatures

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Open Letter Signatures

Although we appreciate the interest of all health professionals in this issue, we will be adding only the signatures of pediatricians to the sign-on letter. We will, however, retain the contact information of other health professionals who wish to provide it and may alert them of other ways to participate in our effort to support the Federal Marriage Amendment.

First Name

Middle Initial

Last Name

Degree

Title

Affiliation *

Additional Title (if any)

City

State

* Organizational affiliation is listed for identification purposes only.

The following Additional Contact Information will NOT be published anywhere, but is needed in case we need to contact you for purposes related to the letter.

Street Address (NOT PUBLISHED)

City (NOT PUBLISHED)

State (NOT PUBLISHED)

ZIP (NOT PUBLISHED)

Phone (NOT PUBLISHED)

EMail address (NOT PUBLISHED)

By providing us with your contact information and clicking the "SUBMIT" button below, you are giving us permission to add your name to our pediatrician sign-on letter. This letter will be distributed to Members of Congress and entered into the Congressional record. You are not joining an organization or obligating yourself to further involvement.

Example of how your name will appear on letter:

John J. Doe, MD, PhD
Director, Research Foundation
Children’s Medical Center
Professor of Pediatrics
Martin University School of Medicine
Martin, MA