LOUISIANA ACADEMY OF FAMILY PHYSICIANS
Family Doctor of the Day
Volunteer today!!!!!
The Louisiana Academy of Family Physicians is asking its members to sign up to be "Family Doctor of the Day" at the capitol during the 2008 Legislative Session. This program will enable the LAFP to build an effective relationship with our senators and representatives; a relationship that should be maintained if our views and suggestions concerning health care are to be heard. We need volunteers for two hour shifts: Morning shift is 10:00 am t0 12:00 pm, and Afternoon shift is 2:00 pm to 4:00 pm, Monday through Thursday as indicated below. You will be asked to perform non-invasive type procedures. Please complete and submit this application indicating your preferred date and time slot(s). Once you make your selection you will receive confirmation. A parking spot is available at the capitol for your convenience and you will be covered under the state malpractice insurance when providing your services.
Complete and submit the form below. You will be contacted by a representative from the LAFP office.
NAME:
HOME PHONE:
OFFICE PHONE:
FAX:
EMAIL:
HOME ADDRESS:
OFFICE ADDRESS:
FIRST CHOICE:
June 18th morning
June 18th afternoon
June 23rd afternoon
SECOND CHOICE:
June 18th morning
June 18th afternoon
June 23rd afternoon
Questions or Comments:
Indicates Response Required