Proposed Disaster Medical/Health Legislation

August 2001

Organization Feedback Form

The _______________________________ has reviewed the Proposed Legislation, dated April 4, 2001, and adopts the following position regarding that document:

Please select the choice that best reflects the position of your organization:

q We fully endorse the proposed legislative language as written.

q We support in concept the proposed legislative language as written. ^{(Please Explain Below)}

q We would fully endorse the proposed legislative language if the following revisions were made: (Please Explain Below)

q We cannot endorse the proposed legislative language for the following reasons: ^{(Please Explain Below)}

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Name: _____________________________ Title: ____________________________

Address: _________________________ Phone: ____________________________

Email: ________________________________

Signature: ______________________________________________________