FORUM 2012 Registration
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1. STRONGER BRIDGES TO HEALTH FORUM - REGISTRATION

 
Thank you for your participation in the 2012 Stronger to Bridges to Health Forum, Wednesday June 6, 2012. The last date to Register is on: May 30, 2012. To get into the early bird raffle, you must register by May 15, 2012.


Please complete all of the registration fields below. We will be sending you a confirmation closer to the event. If you register and cannot make it to the event, please notify us to allow space for others to attend.

Cost: The forum is free and sponsored by the San Francisco Health Plan. However, to ensure forum costs remain affordable, we ask that in return, you only register if you know you will be attending. Additionally, space is limited and we do not want to turn people away for spots taken up by persons who do not show up to the forum.
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1. Please tell us about yourself. We will be sending you information to the contact information below. Please ensure that you provide us with accurate information.
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2. Are you a Certified Application Assistant (CAA) or an Eligiblity Worker?
3. Are you the first time attending Stronger Bridges to Health Forum?
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4. Meal Preference (check one):
5. Please select TWO workshops you would be interesting in attending for MORNING Session:
6. Please select TWO workshop session you would like to attend for AFTERNOON Session:
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7. Are your agency interested in participating in Community Resource fair?
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8. Please check off the type of organization you represent:
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