Thank you for your interest in participating in Ridgeview's DoTopia program. To participate, your organization must serve people within Ridgeview’s service area (Carver, northern Sibley, southern Wright, western Hennepin and eastern McLeod counties) and must be a nonprofit organization. Please complete the following information. A representative from Ridgeview will notify you when your DoTopia code has been added to the Family Health Manager platform and is ready for promotion to your members.

* 1. Organization name

* 2. Organization address

* 3. City

* 4. State

* 5. Zip

* 6. Phone

* 7. Primary Contact

* 8. Website

* 9. Email address

* 10. Type of Organization

* 11. Person completing this form (if different from primary contact)

Thank you! Ridgeview staff will contact you within 1-3 business days. If you have questions, please leave a message for Ridgeview Community Relations at 952-442-8084.