Join the Key Contact Program

Please complete this enrollment form to join the over 5,600 American College of Physicians (ACP) Key Congressional Contacts. During the congressional session, the College will send you Legislative Alerts asking you to contact your U.S. Representative and/or Senators on issues affecting internists and their patients. Thank you for your participation, your grassroots advocacy is critical to ACP's effectiveness on Capitol Hill!

Note: Fields marked with * are required.
Name *
Home/Voting Address *
City *
State *
Home ZIP code*
Daytime Phone *
Fax
Email
ACP #
 
*Please indicate your Membership category:
Master
Fellow
Member
Associate
Honorary Fellow
Student Member
Affiliate
Nonmember
 
If your work ZIP code is different from your home ZIP code, please list your work ZIP code here (to identify if your home and office are in different congressional districts):

 

  1. Do you already have a relationship with any member of the U.S. House of Representatives or Senate?
    Yes
    No

  2. If yes, please specify the name of the legislator(s) you know and your relationship.
    Legislator:
    Relationship:
    Relative
    Friend
    Patient
    Involved/Contributed to Campaign
    Other:


    Legislator:
    Relationship:
    Relative
    Friend
    Patient
    Involved/Contributed to Campaign
    Other:

  3. Have you ever been involved with a political campaign? Have you ever attended or helped organize a fundraiser for a political candidate? Please describe these activities/events and specify the candidate(s) who benefited from them.

For more information about ACP's Key Contact Program, call 800-338-2746, ext. 4532.

Related Links

Public Policy Virtual Library

The Public Policy Virtual Library (PPVL) is a repository of ACP's current and historic policies and the Policy Compendium.