Please complete this survey to register for one or more of the 2019 town hall meetings to discuss the Mother Infant Health & Equity Improvement Plan.

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* 1. First and Last Name:

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* 2. Which town hall meeting(s) will you be attending?

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* 3. Please provide your email to receive directions and parking information:

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* 4. Which category best describes you? Please select all that apply

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* 5. If applicable, institution/organization:

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* 6. Please let us know if you have any dietary restrictions or preferences:

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* 7. Please let us know if you are in need of any accommodations:

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* 8. Would you like to be added to our list serv to receive updates on the Mother Infant Health & Equity Improvement Plan and future events?

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