Thank you for your interest in joining the Children's Action Network (CAN), a grassroots program of the Government Relations Department at Nationwide Children's Hospital. Please complete the information below to join the network. The information you share is confidential and will be used only for CAN activities.
 
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How did you learn about Children’s Action Network?
Check all that apply:

   Membership drive within the Hospital
  Advocacy Grand Rounds
  Legislative Update
  Referred by a member
  Brochure
 

Other:
 

What is your relationship to Children’s Hospital?
Check all that apply:

   Hospital Employee
  Hospital Leadership/Administration
  Nurse
  Pediatric Resident
  Trustee
  Hospital Based Medical Staff
  Community Based Medical Staff
  Community Based Referring Physician
  Women's Board
  Twig Member
  Kinder Key
  Pleasure Guild
  Development Board
  Donor
  Patient/Family of Patient
  Business/Private Sector
  Hospital Volunteer
 

Other:
 

Please select your areas of interest.
Check all that apply:

   Children without health insurance
  Medicaid funding
  Graduate Medical Education (GME)
  Child Abuse and neglect
  Children with special health care needs
  Pediatric research
  Immunizations
  Injury prevention/trauma
  Nutrition/obesity/fitness
  Mental/behavioral health
  Malpractice/tort reform
  Any issue
 

Other:
 

Occasionally, the Children's Action Network will ask you to make direct contact with your legislative representatives and also any legislators with whom you have a personal relationship. Please indicate below all of the ways of communicating with your legislators on issues that impact the Nationwide Children’s Hospital that you would be willing to undertake on behalf of the Children's Action Network.
 

Check all that apply:

   Email
  Letters
  Fax
  Telephone Call
  Personal Visit
  I am not willing to contact legislators directly
 

Do you have a business, friendship or other relationship with a state legislator or Member of Congress (House or Senate) or a member of the current Local, State or Federal administration? Would you consider using that relationship on behalf of Children’s Hospital on an issue of importance: If so, please identify these persons below.
 
You can select more than one person by holding down the "ctrl" key (on a PC) or the Command key (on a Mac) while you click with your mouse.
 

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