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admin@vafp.org
About
Board of Directors
Career Center
Contact Us
Mission & Vision
Staff Directory
VAFP Foundation
VAFP Magazine
Membership
Academy Awards
Committees
How to Join
Membership Benefits
Pay Your Dues
POEM Subscription
CME
Winter Family Medicine Weekend
2023 ABFM Family Medicine Certification (KSAs)
VAFP 2023 Annual Meeting – July 13-16, 2023 – Virginia Beach – More information Spring 2023
Immunize VA – Adult Vaccination ECHO Series
AAFP CME
Report My CME
Advocacy
AAFP Advocacy
Bill Finder
FamDocPAC
Family Physician of the Day
Find My Legislator
Speak Out
Become a VAFP Legislative Key Contact
Resident & Student
Choose Virginia Scholarships
Resident Spotlight
2022 Scholarly Symposium
Med Ed and Clinical Findings
Medical Management
Prevention & Diagnosis
Resident & Student Lounge
Find a Mentor
Get Involved in the VAFP
Join the VAFP Board of Directors
Join a Committee
AAFP Opportunities
VA Residency Programs
VA Medical Schools
Loan Repayment Resources
Exhibits & Sponsors
News
Become a VAFP Legislative Key Contact
Key Contact Survey
Key Contact Survey
Please provide the following information:
Name:
*
Practice Name
*
Home Address:
*
Home City/State/Zip:
*
Work Address:
Work City/State/Zip:
Email:
*
Phone Number:
*
How well do you know your home/workplace's district Delegate or Senator?
Not at All
Know by name only
Have had occasional direct contact with my Delegate or Senator
My Delegate or Senator is a patient of mine
Other (please specify)
Other (please specify)
Please list any legislators with whom you presently have a relationship.
Would you like to participate in VAFP sponsored activities in order to meet or expand your relationship with your Delegate or Senator?
Yes
No
Would you like to be a point of contact for your legislator on family medicine issues?
Yes
No
Are you a donor to FamDocPAC (Family Medicine's Political Action Committee)?
Yes
No, I've never heard of FamDocPAC
No, I don't care to make contributions to a PAC
No, I would consider giving, but I don't know what FamDocPAC does
No, I want to donate, but I don't know how to give to FamDocPAC
Are you aware of how the FamDocPAC is utilized?
Yes, I understand how FamDocPAC is used
Yes, but I would like to receive more updates on FamDocPAC activities
No, I need more information regarding how FamDocPAC is used
Which of the following FamDocPAC fundraising events would you be most likely to attend?
Evening/Weekend FamDocPAC Reception
FamDocPAC Golf Tournament
Regional Legislative Roundtable Discussions
I would not attend an activity; I would instead prefer email/telephone/mailing solicitations
Other suggestions (please specify)
Other suggestions (please specify)
Do you have any additional comments regarding the Key Contact Program or the FamDocPAC?
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