IHS Tribal Consultation Registration Form – Proposed Realignment

Description:
Thank you for registering for the Indian Health Service (IHS) Tribal Consultation on the proposed IHS realignment. Please complete the fields below to support planning, seating, and coordination for in-person and virtual sessions. Supporting materials, including the narrative, draft organizational chart, and FAQs, are available at: www.ihs.gov/newsroom/triballeaderletters/.

SECTION 1 – PARTICIPANT INFORMATION

Question Title

1. First Name (Required.)

Question Title

2. Last Name (Required.)

Question Title

3. Title / Role (Required.)

Question Title

4. Organization Type (Required.)

Tribe

Tribal Organization

Urban Indian Organization

Federal Employee

Other (please specify)

IHS Tribal Consultation Registration Form – Proposed Realignment

Question Title

1. First Name (Required.)

Question Title

2. Last Name (Required.)

Question Title

3. Title / Role (Required.)

Question Title

4. Organization Type (Required.)

Question Title

5. Tribe / Tribal Organization / UIO Name (Required.)

Question Title

6. Email Address (Required.)

Question Title

7. Phone Number (Required.)

IHS Tribal Consultation Registration Form – Proposed Realignment

Question Title

* 1. First Name (Required.)

Question Title

* 2. Last Name (Required.)

Question Title

* 3. Title / Role (Required.)

Question Title

* 4. Organization Type (Required.)

Question Title

* 5. Tribe / Tribal Organization / UIO Name (Required.)

Question Title

* 6. Email Address (Required.)

Question Title

* 7. Phone Number (Required.)

1. First Name (Required.)

2. Last Name (Required.)

3. Title / Role (Required.)

4. Organization Type (Required.)

5. Tribe / Tribal Organization / UIO Name (Required.)

6. Email Address (Required.)

7. Phone Number (Required.)