Society for Maternal-Fetal Medicine

The State Liaison Network (SLN) is a group of SMFM leaders that are instrumental in state level advocacy and implementation of state-based public health programs. Whether you are a current SLN member or a new member, thank you for using this survey to provide your most current contact information and sharing your involvement in public health and advocacy initiatives in your state.

Fields with an asterisk (*) are required.

Are you a member of SMFM? (Please note this is required to become a State Liaison) *

First Name *

Last Name *

Salutation

Credentials

Email *

Phone Number *

Would you like to be added to the SLN WhatsApp group and your state-specific WhatsApp chat? *

Home Address (this is so we can determine your elected officials) *

Institution *

Institution State *

Are you involved with your state MMRC? *

If yes, what is your role with your state MMMRC?

Are you involved with your state PQC? *

If yes, what is your role with your state PQC?

Are you active in efforts to implement AIM bundles in your state? *

If yes, what is your role with AIM bundles in your state?

Are you a leader in other efforts to improve maternal and infant health in your state? If so, describe your role.

Do you have relationships with any of your federal or state elected officials and/or their staff? If yes, please share details below.

Do you serve in a leadership role or actively advocate with any other organizations focused on maternal and infant health? (ACOG, March of Dimes, Planned Parenthood, NARAL, etc.). If yes, please share details.

Anything else SMFM staff should know about you that is relevant to your SLN membership?

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