C. diff Advocates Council Application
Thank you for your interest in joining the Peggy Lillis Foundation's Advocates Council. Please complete the questionnaire below and a member of the PLF team will be in touch shortly to arrange a phone discussion.
First Name
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Middle Name or Initial
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Last Name
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Street Address
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Suite/Floor
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City
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State
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Zip
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Phone
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Email
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Have you been in touch with PLF before?
Please briefly share your experience with clostridium difficile infections (your story, your loved one's story, etc.)
(If you've previously shared your story with PLF, you can just note that.)
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Do you have a specific way you want to support the growing movement to reduce the harm caused by C. diff infections?
Please check all that apply.
Required
Do you have expertise and/or experience in the following areas?
Please check all that apply.
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2017 C. diff Advocacy Summit
Are you available to attend the Peggy Lillis Foundation's 2017 C. diff Advocacy Summit on Thursday, April 27 in New York City? PLF will provide travel and lodging.
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