KYACHW Quarterly Meeting Registration
June 23, 2022 at 10:00 a.m.
Juniper Hills Park
Jack Williams Shelter
800 Louisville Road
Frankfort, KY

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* 1. Please fill out the information below:

Name

Organization

Organization Address

City

State

ZIP/Postal Code

Email Address

Phone Number

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* 2. Lunch will be provided, do you have any food allergies or dietary restrictions we need to be aware of?

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* 3. If you are Certified Community Health Worker place your number here.