Lymphedema Treatment Act

STATE ADVOCACY TEAM SIGN-UP FORM

All fields are required. If you do not know your Congressional district number,
or the name of your Congressperson, you can locate that information here.

After joining, you will receive an email introducing you to your state's members.
That email will contain everyone’s name and contact information, including yours,
so that team members can communicate freely and coordinate advocacy efforts.

Please consult the State Teams page of our website if you need additional
information before joining, or if you want to contact us with a question.

* indicates required

State w/ District # (examples: NY-28, SD-At Large) *

First and Last Name of Your Congressperson *

Your First Name *

Your Last Name *

Email Address *

Phone Number *

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Mailing Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Briefly Describe Your Relationship To Lymphedema *

Are There Particular Ways You'd Like To Help? *

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