Expert Advocate

To become a contributing member as an Expert Advocate, please complete the following information. If a given field is not applicable to your situation, simply enter “N/A” in that field. All information will be treated confidentially and not shared with others.

Prefix (Dr. Mr. Mrs. Etc.)

First Name:

Last Name:

Street Address 1:

Street Address 2:



Zip/Postal Code:

Day Phone:

Night Phone:

Cell Phone:

Fax Number:

EMail Address:

If the following information is available on the Internet, simply indicate the URL in the applicable box. If the information is not available on the Internet but can be sent via email, please indicate as such in each applicable box and send it to 

Educational Background: Please list all degrees including areas of concentration, dates and names(s) of Universities:

Please indicate your area of advocacy:

Please list any media exposure you may have had:

Please provide the names of any books you may have published:

Please provide a list of  any published articles as well as the name of the outlets:

After pressing the “Submit” button and the “hour glass” disappears, please use the links below or the buttons in the upper left to navigate further throughout the website.

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