Thank you for your interest in joining Reach Out and Read’s Medical Leadership! We look forward to connecting with you. Please provide your contact information, areas of expertise and interest, and ways you’d like to engage more with Reach Out and Read in your Affiliate (state) and nationally. By signing up to join our community, you will receive a quarterly newsletter. Please also let us know if there’s anything we should know happening in your Reach Out and Read world that we can address and share with all clinicians.

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* 1. Name

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* 2. Email

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* 3. Cell phone

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* 4. State

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* 5. Specialty/Credentials

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* 6. Areas of expertise (and interest)

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* 7. In which of the following ways would you like to engage more?

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* 8. If you’d like to share anything happening in your Reach Out and Read practice that we should know or address, please include it here.

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