MKE Elevate Action Team Meeting #3 RSVP

The City of Milwaukee Health Department needs your help to elevate the health of the Milwaukee community! Get involved and help us develop a plan to promote positive mental health, create an inclusive fair society, and improve economic security with the goal of creating safe and healthy neighborhoods.

Please complete the following survey to indicate your interest in attending the MKE Elevate Action Team Meeting #3. Additional meeting information will be sent as the date approaches. If you are a member of an organization and not able to attend, personally, we encourage you to identify another individual to attend on behalf of your organization.

Question Title

* 1. Your Name:

Question Title

* 2. Email Address:

Question Title

* 3. Phone Number:

Question Title

* 4. Mailing Address:

Street Address:

City/State/Zip:

Question Title

* 5. Organization Name (if applicable):

Question Title

* 6. Which of the following best describes the primary work of your organization?

NOT APPLICABLE

Health Care

Government

Education

Nonprofit

Other (please describe)

Question Title

* 7. Organization Website URL (if applicable):

Question Title

* 8. Social Media Information (e.g. Facebook, Twitter, LinkedIn, Instagram, etc.):

Question Title

* 9. Please indicate your interest and availability in attending the MKE Elevate Action Team Meeting #3:

I am PLANNING TO ATTEND

I am NOT ABLE TO ATTEND, but am interested in learning about future meetings

I am NOT INTERESTED in attending this or future meetings

I am not able to attend, but ANOTHER INDIVIDUAL from my organization will attend on my behalf. Please provide contact information of the individual attending on your behalf:

Question Title

* 10. Please indicate which ACTION TEAM you are interested in joining. Please select all that apply:

Positive Mental Health Action Team
(e.g. Reduce chronic stress and improve social and emotional support; Reduce alcohol misuse including binge drinking; Reduce prescription drug and opiate misuse including overdose; Improve access to mental health services)

Fair, Inclusive Society Action Team
(e.g. Eliminate racism; Eliminate discriminatory laws and practices; Address the impact of historical trauma and adverse childhood events; Improve access to culturally and linguistically appropriate services)

Economic Security Action Team
(e.g. Improve access to employment that provides family supporting wages and benefits; Improve access to affordable healthy food; Improve access to affordable safe housing; Improve access to, and quality of, basic services, such as education and transportation)

NOT INTERESTED AT THIS TIME

Question Title

* 1. Your Name:

Question Title

* 2. Email Address:

Question Title

* 3. Phone Number:

Question Title

* 4. Mailing Address:

Question Title

* 5. Organization Name (if applicable):

Question Title

* 6. Which of the following best describes the primary work of your organization?

Question Title

* 7. Organization Website URL (if applicable):

Question Title

* 8. Social Media Information (e.g. Facebook, Twitter, LinkedIn, Instagram, etc.):

Question Title

* 9. Please indicate your interest and availability in attending the MKE Elevate Action Team Meeting #3:

Question Title

* 10. Please indicate which ACTION TEAM you are interested in joining. Please select all that apply:

Question Title

* 11. Please feel free to add additional comments or ideas below: