DAAHR Membership Form

Redefining the Role of Government as it Affects the Lives of People with Disabilities

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Use this form to be added to the Disability Advocates Advancing our Healthcare Rights membership. You will receive periodic news updates and recommended action steps.

Please read all of these instructions first:

This form was designed to be accessible. See "Special instructions for Jaws Users below."

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Special instructions for Jaws Users, 7.0 or earlier. Click Here.

Today's Date (like 9/1/2011)*
Your Full Name*
Street Address (ML)*
City or Town*
State*
Zip Code*
Telephone or TTY
Email Address*

Do you think managed care is a good idea?	Yes No Maybe
Why is managed care important? (ML)
What is the most important change that you woulkd like to see? (ML)


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*Required