COALITION FOR UNIVERSAL HEALTH CARE

2709 Ross Road, Chevy Chase, MD 20815, 301-588-4157

PRINT Name…………………………………..……………….………….Phone…………………

Address……………………………………………………………………(zip)...............................

E-mail……………………………………………………..……………Date………………………

Do you and your spouse, children, and parents all have health insurance coverage?…………

Are you generally satisfied with that coverage? ….…………If not, why not? …………………..

………………………………………………………………………………………………..………

Do you favor adoption of a new health care payment system for everyone, similar to Medicare, in

which the fees of private doctors are paid by a publicly funded agency? …………………..

Your help is needed to promote progress toward high-quality health care coverage for everyone. Please check each of the following ways that you would like to help.

….. Call or write to members of Congress and your state legislature.

….. Write letters to the editor and/or op-ed articles for newspapers and magazines.

….. Call in comments to radio and TV talk shows.

….. Join a committee of the Coalition for Universal Health Care.

….. Meet with legislators.

….. Meet with newspaper reporters, editors, and other media personnel.

….. Testify at legislative hearings on health care bills.

….. Participate in rallies or demonstrations calling for health care reform.

….. Give speeches on health care reform to local organizations.

….. Urge study of and action for health care reform within organizations of which you are a member (both by individuals and by the organization).

….. Call attention to the need for health care reform when attending candidate forums, town meetings, and other public functions.

….. Other (specify)……………………………………………………………………………….

 

Suggestions and comments…………………………………………………………..………………………

(Write on the back of this page if you wish.)