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STEP 2: Tell Congress You Care
Completion of this form puts you on the map and allows you to tell Congress about your priorities for children in health reform. The next step will allow you to personalize your message through a written, photo, or video testimony or a link to your personal blog entry that highlights why you believe children must be included in health reform.
Field names in red are required.
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First Name Last Name * Gender *
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Female
Address * City State Zip Code *
Email Address (Username) * Already Signed up? Log in here.
Please contact me about how I can help in future efforts to ensure
children's needs are met in health care reform.
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Help us learn more about you (Check all that apply)
 I am the parent of a child under 18
 I am another family member (e.g aunt, uncle, grandparent, cousin)
 I am a pediatrician
 I am another healthcare provider
Are you affiliated with (employee of or family member served by) a children's hospital?
Yes   No
When you think about children and health care, what is your greatest concern? Do you think Congress should fulfill President Obama's campaign pledge to provide health care coverage for all children?
 Health care coverage for all children
 Access to health care
 Cost of health care
 Quality of health care
  Yes
 No
 
 
I confirm I am at least 18 years old
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 Please confirm your age to continue.

All material—written, photography and video — on the Speak Now for Kids Web site is copyrighted and should not be copied, saved, reproduced or distributed without permission of the National Association of Children’s Hospitals.