Coalition Sign-Up Form
YES! You may list my healthcare district as a supporter of Californians Allied for Patient
Protection (CAPP), a coalition of healthcare districts, hospitals, healthcare providers,
community clinics, health centers, labor, business, and local government groups dedicated to protecting
California’s Medical Injury Compensation Reform Act (MICRA). MICRA ensures injured patients receive
fair compensation while also preserving patients' access to healthcare by keeping doctors, nurses and
healthcare providers in practice and hospitals and clinics open. Changes to MICRA would increase
healthcare costs in California by billions of dollars, resulting in increased healthcare premiums for
consumers and increased costs to California’s general fund for state-sponsored healthcare services.
Please complete the following information:
Healthcare District Name
(How should the organization be listed in CAPP’s materials?)
Name
Title/Occupation
Address
City
State
Zip
________________________________________________________________________________________
Phone
Fax
E-Mail Address
Signature
Date
Return this form to:
Victor Christy, Public Affairs Director
Californians Allied for Patient Protection
1215 K Street, Suite 2015
Sacramento, CA 95814
Fax: 916-448-0234
[email protected]