Health Equity Event September 2017

Registration for the Advancing Health Equity Community Conversation

Wednesday, September 13th, 3:00 PM - 5:00 PM
Northwest Indian Community Development Center, 1819 Bemidji Ave. N., Bemidji, MN 56601

Please complete and submit the information below to reserve your space.

Email address is required to register: If you don't have an email address, please call: 651-201-5813 and someone will help you.

Please enter the information below to register for the event:

First Name

Last Name

Organization

Title/Role

Phone

Please list or describe what racial/ethnic, cultural, geographic or other communities you represent (if applicable):

Have you been to an MDH Community Conversation in the past?

How did you hear about this event?

If you or others who will be in attendance with you will need interpreting or ASL, please indicate language(s) or needs below:

If you have a disability and may require accommodations in order to fully participate in this activity, please check the box below. You will be contacted by someone from our staff to discuss your specific needs.

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