Mid Shore Health Improvement Coalition -RSVP-

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please take a few moments to complete this form to indicate your anticipated participation in the Mid Shore Health Improvement Coalition.

While our focus will broaden over time to address multiple health priorities for the Mid Shore, our first priority is the prevention and management of diabetes. The coalition will work to create the first Diabetes Action Plan, and workgroups will meet to develop goals, objectives, and strategies across these sectors: Healthcare, Schools, Communities, and Businesses.

The first virtual coalition meeting for regular voting members will be held on April 22, 2021 from 1-2 pm.
Workgroups will meet virtually in May, June, July, and September (at a time to be determined by each group).

There are two ways to get involved:
1) Join the coalition as a regular voting member and serve on a temporary diabetes workgroup of your choice.
2) Join the coalition as a non-voting member. Serve on a temporary diabetes workgroup of your choice.

For questions, please contact nicole.morris@maryland.gov

Email *

First and Last Name *

Title *

Organization *

Phone *

I am interested in serving on the Coalition. *

Yes, I would like to serve on the coalition as a voting member. I plan to attend the first meeting on April 22nd.

Yes, I would like to serve as a voting member but I can not attend the virtual meeting on April 22nd.

Yes, but I am not interested in being a voting member. I would prefer to just serve on a temporary workgroup to address diabetes. Please contact me with the workgroup schedule.

No, but I can recommend someone else at my organization.

Clear form

Never submit passwords through Google Forms.

This form was created inside of State of Maryland. Report Abuse

Forms