Key Contact Form

Become a Key Contact

Please fill out the form below and we will be in touch shortly.

CAFP/AAFP Member ID

First Name

Last Name

Email

Preferred Phone

Address Line 1

Address Line 2

City

State

Postal Code

Confirmation

Yes, I want to become a Key Contact

Your Legislator(s) or Congressional Representatives, if known. Please briefly describe your relationship (e.g. constituent)

Legislators

Please list any areas of interest or expertise (e.g. women's health)

Expertise / Interest

Contact Information