Lived Experience Integration® into Quality Improvement Community of Learning Registration

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

Get ready for this energizing 4-week sprint! Every week, gather virtually with peers to work through obstacles and share helpful insights and advice from fellow members of the group. Our amazing faculty will provide guidance so that everyone's voice is heard. You'll also get brief but purposeful homework every week which is a great way to maximize your experience and make sure you come prepared each time!

Please fill out one form per person participating.

Please be sure to select the correct option below. Cohorts have limited seats, so please register early.

Email *

Which class are your registering for? *

January - For PQC's and other state level agencies (12pm ET Jan 15, 22, 29, Feb 5)

February - For hospitals and other local level agencies (12pm ET Feb 26, March 5, 12, 19)

What is your first and last name? *

What is the name of your organization? *

What state are you in? *

What is your role in the organization?

How did you hear about this educational opportunity?

MoMMAs Voices email

MoMMAs Voices social media

Your agency or institution

Word of Mouth

Other:

Clear selection

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

Forms

reCAPTCHA

Privacy Terms

This form was created inside of Preeclampsia Foundation.