Please complete this form to register your school/program to attend HealthFORCE on Fri Oct 4, 2019.

After completing this form, expect to receive an e-mail from The Health Collaborative within 72 business hours with additional details and follow-up!

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* 1. What is the name of your school (and class/program, if applicable)?

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* 2. Please share your name and/or the contact name for this registration.

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* 3. Please share your e-mail address. (Please type CLEARLY and use an e-mail address that is often checked... you can also provide additional e-mail addresses/contacts, if you prefer.)

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* 4. Which HealthFORCE session do you plan on attending?

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* 5. Select the amount of students you plan to bring to a session. (We know it may be hard to know the exact amount at this time. Someone from The Health Collaborative will follow up with you 2-3 weeks before the event to get a more accurate count.) 

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* 6. Do you know any professions/themes/career interest areas your students may have in the field of healthcare? If so, please list!

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* 7. Anything else we should know at this time?

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