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Mohs Surgeons Have No Better Champion than YOU!

Be a leader...in your job, in your profession, in your community, and help shape the future of Mohs Surgery.

The American College of Mohs Surgery Key Contact Program is the Society's grassroots advocacy program. Through the Key Contact Program, members can learn about public policy issues important to our profession and help advance the priorities of the profession through interaction with elected leaders. The program will help Key Contacts, like you, stay informed about developments in Washington that affect you and learn about opportunities to get involved.

Become a Key Contact!
Do you have a relationship with a federal legislator? As an ACMS Key Contact, you work with a federal legislator from your state or district and educate him/her on issues important to you and your patients. Our goal is to match each member of the House and Senate with an ACMS Key Contact.

What is a Key Contact?
A Key Contract is an ACMS Mohs surgeon who is the designated contact for a specific congressional district or state or lives in a district/state of a Member of Congress who serves on a key health related committee. The Key Contact has/will develop a strong, positive relationship with his or her legislators and is willing to contact them, as needed.

Objectives:
The most important role of a Key Contact is to be a liaison. As a Mohs surgeon, you are an important part of helping the College communicate with Members of Congress. You live and vote in your district and/or state, therefore, your voice counts.

What Key Contacts do:
-- Know and understand the Mohs College legislative priorities and initiatives
-- Meet with his/her legislator to review legislative priority issues of the Mohs College

If interested, please sign up by Sunday, July 31, 2011.

Join Us Today!
Brent R. Moody, MD
Chair, ACMS Public Policy Committee

Question Title

* Please provide the following information to join the ACMS Key Contact Program.

Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Personal Email Address:

Website:

Company Name:

Business Phone Number:

Business Fax:

Work Address:

City:

State:

Zip:

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* Home address collected ONLY for matching your elected officials

Home Address:

City:

State:

Zip:

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* We need your help to spread the word about the Mohs College legislative priorities. Please let us know that you would like to get involved:

I would like to join the ACMS Key Contact Program. Register me to receive information about Mohs surgery issues on Capitol Hill and how I can help make the College's voice stronger.

Question Title

* I am willing to:

Write or call my lawmakers

Meet with my lawmakers

Participate in a Legislative Fly-in in Washington, DC

Participate or host a candidate or political event

Speak to newspaper, radio, television reporters

Write a letter to the editor of my local paper

Educate my employees, friends, and family about Mohs surgery issues

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* Please select all that apply:

I would like to participate in the ACMS Key Contact Program but I do not know my legislators yet.

I have a personal relationship with my elected officials at the local, state, or federal level. (Please list names and offices below)

I have a personal relationship with my elected officials' staff members. (Please list names and offices below)

List names and offices here

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* Do you plan to run, or have run, for public office, or serve on a State Medical Board type organization or other key outside entity?

Yes

If Yes, please specify what you have run, or plan to run for

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* Would you categorize yourself as a member of the Derm CAC?

Yes

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* Do you serve on any medical advisory panels for insurance companies?

Yes

If yes, please specify which advisory panels you are a part of