Registration for MAIC Quarterly Meeting Wednesday, Sept. 5, 2018

11:30 a.m.  - 1:00 p.m.
A light lunch will be provided. 

Location: 
Kansas City Health Department
2400 Troost Ave. Lower Level
Kansas City MO 64108

Please fill in the following:
 

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Credentials (RN, MD, etc.)

Question Title

* 4. Affiliation/Employer

Question Title

* 5. Street Address

Question Title

* 6. City

Question Title

* 7. County

Question Title

* 8. State

Question Title

* 9. ZIP Code

Question Title

* 10. Office Telephone Number

Question Title

* 11. Mobile Telephone Number

Question Title

* 12. E-mail Address

Question Title

* 13. How did you hear about today's educational event?

Question Title

* 14. Are you a current member of Mother & Child Health Coalition?(Membership has its benefits, and is encouraged.) 

T