Mother Infant Health Improvement Plan Satellite Locations Question Title * 1. Which satellite location will you plan on attending? Mid-Michigan - Tuesday, September 25 4pm - Tuscola County Health Department Mid-Michigan - Tuesday, September 25 4pm - Huron County Health Department OK Question Title * 2. First and Last Name OK Question Title * 3. Which category best describes you? Community Member (Parent, Grandparent, Guardian, Caretaker, etc. ) Social Worker Pediatrician OB/GYN Home Visiting Staff Public Health Professional (Program Coordinator/Manager, etc.) Midwife/Doula Physician Nurse Nurse Practitioner Physician Assistant Faith Based Leader Other (please specify) OK Question Title * 4. If applicable, please provide your institution/organization OK Question Title * 5. Are you in need of any special accommodations? Yes No OK Question Title * 6. If applicable, please select the accommodation(s) needed below. American Sign Language Interpretation/Translation CART Assistive Listenting Headset Wheelchair Access Printed Materials in alternative Forms Special Seating Other (please specify) OK Question Title * 7. Please provide your email for updates, directions, and parking information: Email Address OK DONE