Immunize Kansas Coalition | Info Update - Fall 2020

Help us verify and update our information!

Share your communication and strategic team preferences, and current contact information.

Question Title

* 1. Communication Preferences

I would like to receive IKC update emails and meeting invites.

I would like to receive IKC update emails only.

Please remove me from all IKC communications.

Comment or question:

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* 2. Strategic Team Preference

Improved Systems Performance (Sarah Good, Chair)

Education and Awareness (Carrie Delfs, Chair)

Policy (Charlie Hunt, Chair)

Funding and Grant Development (Robin Simmons, Chair)

Not sure/I would like to learn more about the teams/Not applicable

Comment or question:

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* 3. Name (including post-nominal letters - MD, RN, MPH, etc.)

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* 4. Email Address

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* 5. Phone

Work

Mobile

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* 6. Organization

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* 7. Department or Office

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* 8. Role/Title

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* 9. Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Immunize Kansas Coalition | Info Update - Fall 2020

Help us verify and update our information!

Question Title

* 1. Communication Preferences

Question Title

* 2. Strategic Team Preference

Question Title

* 3. Name (including post-nominal letters - MD, RN, MPH, etc.)

Question Title

* 4. Email Address

Question Title

* 5. Phone

Question Title

* 6. Organization

Question Title

* 7. Department or Office

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* 8. Role/Title

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* 9. Mailing Address

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* 10. Dietary Preferences for IKC Meals (for future in-person meetings)

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* 11. Do you have any questions or feedback for IKC Staff or Board?