Kaiser Permanente Marin Sonoma Community Benefit

 
Thank you for your interest in the Kaiser Permanente Marin Sonoma Community Benefit programs.

This information will be used to communicate information from Kaiser Permanente Marin Sonoma to you.

Kaiser Permanente’s Community Benefit Program, Marin/Sonoma Area, is administered through the Public Affairs Department on behalf of the San Rafael and Santa Rosa Medical Centers.

1. ORGANIZATION NAME
2. PLEASE PROVIDE A BRIEF DESCRIPTION OF THE ORGANIZATION
3. ORGANIZATION WEBSITE ADDRESS
*
4. MAILING ADDRESS
5. organization status
6. CONTACT PERSON: NAME
7. CONTACT PERSON: TITLE
8. CONTACT PERSON: EMAIL ADDRESS
9. CONTACT PERSON: PHONE NUMBER
10. IF APPLICABLE, Please list any Kaiser Permanente physicians and/or staff affiliated with your organization, e.g. as a board member, volunteer, or advisor. Please list names and include a brief description of their involvement.

Please DO NOT list individuals which provide monetary support or donations only. Thank you.
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