JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Medical Debt: Let’s Prevent and Erase It
When:
Tuesday February 20th 6PM to 8PM
Where: Zoom
or in person at
CoLab 18
100 S. Commons, Ste. 100, Pittsburgh, PA 15212 (on the northside)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your First Name
*
Your answer
Your Last Name
*
Your answer
Your phone number (optional)
Your answer
Can we text you reminders at the number above?
Yes
No
Clear selection
Organization (if any)
Your answer
How will you attend?
*
In person
By zoom (we'll send you the zoom link after you register)
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Just Harvest.
Report Abuse
Forms
