Advancing Equity in OHP Healthcare Listening Session - Lane Co

Please answer the following questions to register for our Lane County session.

Thursday, December 5
5:30 - 7:30 p.m. (includes dinner)
Hilyard Community Center
2580 Hilyard St., Eugene, OR 97405

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* 1. Who is attending?

Please enter your first and last name.

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* 2. If you represent a community agency or clinic that serves OHP members, please include the name of your agency.

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. Number of adults in your party (over age 18)

1

2

3

4

5

6

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* 6. If you are bringing children, how many will participate in the children's activity?

1

2

3

4

5

6

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* 7. Language assistance services are available to you free of charge. Will you or someone in your party need an interpreter at the event?

Spanish

ASL

Other (please specify)

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* 8. Accommodations for individuals with disabilities are available free of charge. If you or someone in your party will need assistance, please describe your need.

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* 9. Please confirm you will be attending the event.

Thursday, December 5, 5:30 - 7:30 p.m. (includes dinner)
Hilyard Community Center
2580 Hilyard St., Eugene, OR 97405