First Name * Last Name * Primary email * Mobile Phone Number (we promise we won't call or text often!) Part of Climate Health Now's advocacy efforts involve engaging with our California State Legislators -- the only way to know your specific Legislators is by street address! This information will not be shared out in any way and only used for internal organizing efforts! Country * United StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Republic of theCongo, The Democratic Republic of theCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSingaporeSint Maarten (Dutch Part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Street Address * City * State * We are an organization for the California health community. If you reside outside of California, please join as a supporter! You can access our supporter form here: https://climatehealthnow.ourpowerbase.net/node/7. County of residence * Home Zip Code * Are you a member of the health community? * Yes No Which of the following best describes your current status? Currently working Student Retired Climate Health Now defines this wider health community to include, but not be limited to, those involved in public health, clinical care services, community healing, health sector administration, health research, and development of healthcare products. We welcome trainees, students, and those who have retired from these fields. Please read here for more information (refer to this document). Type of health community member (check as many as apply) * Acupuncturist Athletic trainer Audiologist Chiropractor Clinic lab technologist or technician Dental hygienist Dentist Dietitian or nutritionist Doula Emergency Medical Technician or Paramedic Genetic counselor Healthcare administrator Home health care aide Massage therapist Medical assistant or licensed vocational nurse Mental health professional Midwife Nursing assistant Occupational therapist Optometrist Pharmacist Phlebotomist Physical therapist Physician assistant Physician or surgeon Podiatrist Public health Radiology technician (e.g., sonographer, radiation therapist, nuclear medicine, cardiovascular or MRI technician) Registered nurse, nurse practitioner, nurse anesthetist, certified nurse midwife Respiratory therapist Speech therapist Surgical assistant or technologist Social worker Pharmaceutical / Medical device industry Health insurance industry Traditional healer / indigenous medicine practitioner Patient advocates / Members of patient advocacy groups Religious leader / healer Health educator Other type of health care worker / member of health community I'm not a member of the health community https://docs.google.com/document/d/12QzVhW0Eq5eZ59LhMTzgUP_GmxYfGTUr27ryK4hjxxo/edit If you selected "Other type of health care worker / member of health community", Please describe: CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 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