YCCO Community Advisory Council (CAC) Member Interest Form

YCCO Community Advisory Council (CAC) Member Interest Form

You can get this form in any format or language you prefer free of charge. If you would like help filling out this survey, please call customer service: 885-722-8205.

Thank you for thinking about becoming a member of the Yamhill Community Care Community Advisory Council (CAC). By serving on The Council, members help ensure the community voice is represented so that we can create the best member experience possible. 


1.Name:
2.City:
3.Zip code: 
4.Email address: 
5.Preferred phone number: 
6.Preferred communication method:
7.Membership type (Check all that apply):
8.Please check Yes or No for permission to contact you about CAC membership using the preferred contact method you indicated above.
9.Please share a short description of which areas of healthcare or member experience you are most interested in learning about and/or improving, if any.
10.We appreciate your interest in the Community Advisory Council! Please share anything else about you you'd like us to know.