Key Contact

Thank you for your interest advocating for Texas neurology patients.  Use the online form below to register as a "key contact" who will act on legislative alerts from TNS during state and federal debates on healthcare policy.

If you are unsure who your Texas Senator and Representatives are, go to www.capitol.state.tx.us and click on “Who Represents Me?”

You must answer each question in order to submit this form.  If you do not have an answer to the question, please enter N/A.

First Name *

Last Name *

Email *
City *


 
1) Click here if you have a relationship with your hometown State Representative and/or State Senator. *


 

• Please list the official’s name: *

Enter N/A if you do not have an answer to this question.
• What is the nature of your relationship (friend, patient, church member, etc)? *

Enter N/A if you do not have an answer to this question.
 
• Would you be willing to contact him/her if asked? *

 

 
2) Click here if you have a relationship any other Texas elected or appointed official (Governor, Lt. Governor, Secretary of State, Texas Medical Board member, etc) *


 
• Please list the official’s name: *

Enter N/A if you do not have an answer to this question.
 
• What is the nature of your relationship (friend, patient, church member, etc)? *

 Enter N/A if you do not have an answer to this question.
• Would you be willing to contact him/her if asked? *

 

 
3) Click here if you have a relationship with a member of the United States Congress? *


 
• Please list the official’s name: *

Enter N/A if you do not have an answer to this question.
• What is the nature of your relationship (friend, patient, church member, etc)? *

 Enter N/A if you do not have an answer to this question.
 
• Would you be willing to contact him/her if asked? *

 

 
4) Would you be willing to come to Austin and testify? *




 Texas Neurological Society * 401 W. 15th Street * Austin, TX 78701
* (512) 370-1532 * (512) 370-1626 (fax) * www.texasneurologist.org