Please complete this survey to register for one of the 2018 town hall meetings to discuss the Michigan Mother Infant Health Improvement Plan.

* 2. Will you be attending additional meetings?

* 3. First and Last Name:

* 4. Which category best describes you? Please select all that apply

* 5. If applicable, institution/organization:

* 6. Food Restrictions (if allergies, list in the comment box below):

* 7. Are you in need of accommodations?