To commemorate OCHIN’s 20th anniversary, we invite you to share quotes, stories, and photographs that may be highlighted in a commemorative anniversary book, the OCHIN Learning Forum, OCHIN Board and staff events, in the OCHIN member newsletter, and social media posts.

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Organization

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* 5. Title

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* 6. Relationship to OCHIN (Current or Past)

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* 7. Please share your favorite memory, quote or story about your work with OCHIN.

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* 8. Please identify if you have any photos to share and Kate Rohan, OCHIN’s Marketing Events Specialist, will follow up with you via email to collect.

*By submitting the information collected in this form, you give consent to the use of your photographs, stories, quotes, content, video or audio recording in whole or in part without restriction or limitation for any educational, promotional, or any purpose for distribution in OCHIN online and printed publications or any publication in other media without compensation to you, your family and/or the organization you represent. You release OCHIN, their officers and employees, and each and all persons involved, from any liability connected with the sharing or any publication of photographs, images, interviews, stories, quotes, video and/or sound recordings. If you do not wish for any of this information to be used by OCHIN, please let Kate Rohan know at rohank@ochin.org.

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* 9. By checking this box, you confirm that you have read and understood the above policy.*

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