Registration: Single Payer 101 9/27: 10am - 3pm
Thank you for joining PNHP-NY Metro's Single Payer 101 Workshop on Saturday, Sept. 27th from 10am - 3pm. Please fill out the following form so we can better prepare the session for you. Free coffee and lunch included.
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Full address *
Your answer
Phone number *
Your answer
Medical institution affiliation(s), if any
Your answer
What is your main goal for the training? *
Please list your involvement in community and professional groups such as social justice groups, neighborhood political clubs, unions, medical associations, religious congregations, ... etc.
Your answer
Is there anything else you'd like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service