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Contact Form
Wow, we are so glad you are here! This is a brief inquiry survey that will help the APP-PHI team connect with you.
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Email
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Your email
Full name
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Your answer
Preferred Name
Your answer
Are you contacting R-PHI on behalf of an organization?
Yes
No
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If so, what is the name of the organization you currently representing?
Your answer
In what city do you currently reside?
Your answer
How did you hear about the Rural Public Health Innovation?
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Social Media
Internet Search
Word of Mouth
Event or Workshop
Other
What aspects of our mission interests you most? (select all that apply
Volunteering Opportunities
Donating or Fundraising
Attending Events or Workshops
Receiving Support or Services
Learning More About our Impact
Other:
How would you like to get involved?
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I am interested in volunteering my time and skills
I would like to make a donation
I would like to join a specific program
I would like to partner with the organization
Other:
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Please add any additional information you would like our team to know.
Your answer
Please share any questions or concerns you may have for our team.
Your answer
What is the best way to contact you?
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Other:
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Please enter any additional contact information you would like us to have.
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