If you are a member of the media who would like more information on the Freedom 2 Care Coalition, please complete this form. To interview a physician, or if your need is urgent, you may contact the Christian Medical Association media communications department at (423) 844-1000.

1.	First Name *
2.	Last Name *
3.	Media organization name *
4.	Phone *
5.	Email *
6.	Deadline
	When you need to have a response - date and time.
7.	Comments
	Please provide any additional details (125 words max.)
	* Required