NCRA Raise Your Voice Form

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	NCRA provides open and direct communication with its members through its Advocacy and Technical Practice Directors (ATPDs). These board members serve as the liaisons between members and NCRA on matters of advocacy and technical practice. There are four categories: external, internal, legislative, and regulatory. External is a policy or a procedure of a standard-setting organization or other agency (not NCRA); internal is an NCRA policy or procedure; legislative describes issues that are a state or federal initiative or action tied to congress or state legislature; and regulatory describes issues that are a state or federal law tied to regulatory enforcement by a state or federal agency. To bring a Raise Your Voice issue forward complete this Raise Your Voice Questionnaire Form.

*1.

Please Provide the following:

First Name
Last Name
Address
Address
City
US State
Zip Code
Work Phone
Email Address

*2.	What is your primary employment:

*3.	Are you a NCRA Member?

	Yes No

*4.	Do you hold the CTR/ODS Credential?

	Yes No

*5.	What is the issue/concern you would like to address?

	Remaining characters: 4000

*6.	Why is this issue/concern a problem?

	Remaining characters: 4000

*7.	In what ways does it affect your work?

	Remaining characters: 4000

*8.	Where do you see this problem coming from? (Examples: State Legislature, Hospital administration, standard setting organizations.)

	Remaining characters: 4000

*9.	What would you like to see happen/be changed?

	Remaining characters: 4000

10.	Any ideas/solutions on how to fix the issue/concern?

	Remaining characters: 4000

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