Signature Authorization: Print, Sign & FAX

Signature Authorization for Oklahoma Letter

If you would like to sign on to this open letter please fill out the form below and fax it to NAPW at 212 255-9253 ASAP.

By my signature below, I grant the National Advocates for Pregnant Women and the Drug Policy Alliance permission to add my signature to the Oklahoma open letter objecting to the misapplication of child abuse, state murder and/or homicide laws to pregnant women who attempt to continue their pregnancies to term in spite of a drug, alcohol or other health problems. I authorize NAPW and DPA to make small, non-substantive adjustments to the letter in response to feedback from individuals and organizations that agree to sign on.
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Print Name (First Last) and Title (as it will appear if signing as an individual)

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Organization

___ I am signing as an individual

___ Organization for identification purposes only

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___ I am signing on behalf of my organization, you may list the organization on the open letter

___ I am signing as both an individual and on behalf of my organization, you can use both names in the open letter

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Organizational/Individual Contact information:

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Street City State Zip

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Email Address Phones) Fax

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Your Signature and Date Signed