"Nuns on the Bus" for State Medicaid Expansion

Please complete and submit this form to tell us about your interest in joining or leading a team of concerned citizens to advocate with the governor of your state for Medicaid expansion.

Name: *

E-mail: *

Phone: *

State: *

State where you vote and plan to act

Please check all that apply:

I have an established team of people to visit the Governor in our state

I am willing to organize/lead a team

I am willing to join a team

I am willing to act as liaison to NETWORK staff

Check all the options that apply to your willingness to visit the governor of your state in support of Medicaid expansion

Describe your team:

If you have or are willing to organize/lead a team, please describe who would comprise your team.
(e.g. sisters, healthcare professionals, etc.)

Share e-mail?:

Yes

May we share your e-mail with others in your area who are interested in this project?

Accept Criteria: *

Yes

I have read and I accept the criteria for Nuns on the Bus campaigns at www.networklobby.org/notb-local [1]

Summary: *

Yes

I will give NETWORK a summary when the campaign/event is complete, in order that "best practices" can be shared with others.

NETWORK—a Catholic leader in the global movement for justice and peace—educates, organizes and lobbies for economic and social transformation.
NETWORK—un líder Católico en el movimiento global para la justicia y paz—educa, organiza, y cabildea para la transformación económica y social.

Source URL: http://www.networklobby.org/notb-form-medicaid

Links:
[1] http://www.networklobby.org/notb-local