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June 1, 2011 / J. Shaw

Your ObamaCare Personal Waiver Form

I saw this application form for a personal waiver from ObamaCare at Grassfire Nation

If my form won’t work Go right to the source, above,their form will work! This was a great idea by The form is laid out perfectly and is easy to read and short.

The form may be symbolic but it will reach Health and Human Services Secretary
Kathleen Sebelius in a massive public demonstration.

According to  over 2.2 million citizens now have an ObamaCare waiver. SHAW

A Personal Waiver for
Exclusion from ObamaCare
Petition Sponsor:
Grassfire Nation

The Issue

President Obama
knows that his socialist takeover of our healthcare services is a bust, so
he is feverishly doling out waivers to labor groups, unions and political
friends — exempting them from having to participate in his nationalized
plan. Already more than 2.2 million citizens have benefitted from this
latest Obama hand-out with more anticipated.

The Action

In the spirit of
fairness, many Americans are asking, “Where’s My Waiver for ObamaCare?” In
response, Grassfire Nation has launched a national “Personal Waiver”
initiative where citizens can symbolically receive “get-out-of-ObamaCare”
waivers that will be hand-delivered to Health and Human Services Secretary
Kathleen Sebelius in a massive public demonstration opposing ObamaCare and
the President’s playing of political favorites!

Top of Form

Your “Personal
Waiver” States:

Whereas unions, labor groups
including the food services industry and other corporations, and
politically-tied organizations are receiving WAIVERS exempting them from
ObamaCare, andWhereas ObamaCare is an unconstitutional infringement on my rights that are
now being contested in federal courts, andWhereas Obamacare creates a personal economic hardship for my family
and/or my employer.Therefore, I am demanding confirmation from federal authorities of my
personal WAIVER exempting me from ObamaCare.

Sign Here:

First Name:
Last Name:
Address 1:
Address 2:
State: (other)AlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaBritish Virgin IslesBritish West IndiesCaliforniaColoradoConnecticutDelawareDistrict Of Col.Dutch West IndiesFloridaFrench West IndiesGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNetherlans AntillesNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerriNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IsPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaSpanish West IndiesTennesseeTexasUS Virgin IslesUtahVermontVirgin IslandsVirginiaWashingtonWest IndiesWest VirginiaWisconsinWyomingYukon TerritoryZip:
Confirm email:
(Optional)I am also interested in the following issues:

Stop Spending/Balance BudgetDefund ObamaCareProtect Social SecurityOppose government wasteTax Reform/Elminate IRSDefund Planned Parenthood2nd Amendment Support Stop Judicial ActivismOppose Radical Global WarmingOpposition to the Fairness DoctrineExpose Liberal Media BiasSupport our TroopsSupport Education Vouchers

Bottom of Form

Submit your waiver!

must be 18 years of age or older to sign this petition

Please take a moment and add your
name. It costs nothing, your e-mail address will not be sold or given to
anyone else without your permission, and it takes less than five minutes of
your time.

You must be 18 years of age or older to sign this petition.

email me periodic updates on this issue

partner organizations to contact me via email.

Click here to view our privacy policy

Bottom of Form


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