Congressional Briefing on Polycystic Ovary Syndrome (PCOS)
The Metabolic Disorder Wreaking Havoc on Public Health
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Complete the form below to RSVP - Only 20 Spaces Available
Join PCOS Challenge: The National Polycystic Ovary Syndrome Association for a special Congressional Briefing on PCOS.

Date and Time:
Wednesday, September 27, 2017
1:00-2:30 PM

Location:
122 Cannon House Office Building
Washington, DC 20003


First Name *
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Lunch Preference *
Are you available and willing to meet with staffers from your Congressional Representatives' offices on September 27th between 10am-5pm? *
OPTIONAL - Additional Comments
Military Servicewomen
Are you a retired or active duty military servicewoman with PCOS? If so, are you available and willing to speak about your experience with PCOS in the Military during the briefing?
OPTIONAL - Please share with us what you would like your Congressional Representatives to know about your experience with PCOS in the military.
Privacy Statement
PCOS Challenge, Inc. is committed to keeping your personal information confidential. We respect your privacy and will not sell, share or rent your information to anyone for any reason.



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