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ADAP Advocacy Association

Registration Profile

 

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Personal Information
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Last Name:
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Fax: ( ) - ext.

Please check all that apply.

ADAP Recipient 
ADAP State Directory 
AIDS Service Organization 
Government Agency (other than ADAP)
Legislative Staff for Member of Congress or Executive Branch 
Lobbyist for Trade Association 
Mid-Level / Health Professional (i.e., P.A., N.P. / R.N., L.P.N.) 
News Media 
Pharmaceutical Company 
Physician 
Other: Health-Care Related (i.e., hospital, pharmacy, therapy)

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