PDAB Community Partner Network Sign Up Form
Please join our Community Partner Network! Staff from the Colorado Prescription Drug Affordability Board (PDAB) are seeking community partners to help reach Colorado consumers who are directly impacted by prescription drug affordability challenges. The goal of the Community Partner Network is to support outreach to ensure a wider range of Coloradans understand the Board’s work and know how to share their personal experiences affording prescription drug medications.

After you complete this form, the PDAB staff will review your information and connect with you as opportunities arise. Please visit the PDAB website to view the complete list of registered community partners. 

Before you begin: Please note that information submitted through this form may be publicly available. Information collected through this form will be maintained in a Google spreadsheet and select information will be shared on the PDAB website to help community partners and stakeholders stay connected. Please only provide details that you are comfortable being publicly shared.
Sign in to Google to save your progress. Learn more
Your Name *
Contact Information
Please provide your email.
 *
Contact Information
Please provide your phone number.
Your Organization/Affiliation
If you are not affiliated with an organization, please enter "Individual".
 *
Your Role/Title
What type of organization or stakeholder do you represent? *
Please list the communities, populations, regions or areas you primarily serve.
What promotional materials provided by PDAB staff would your organization use? Select all that apply. *
Required
Consent to Contact *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch.

Does this form look suspicious? Report

Google Forms