Request to Address the TMA Board of Trustees

Name *

Medical Society *

Phone *

Email *

Subject Title *

I submit the following item for consideration by the TMA Board of Trustees at its next meeting:

Background: *

Action Requested: *

I will attend the meeting: *

in person

virtually to present the issue.

I will NOT attend the meeting in person. However, another representative will be in attendance. *

Name *	Organization/Position *	Phone # *	Email *
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