Brothers in Public Health - Q1 2024 Focus Group Registration 
Thank you for your interest in participating in the Brothers in Public Health (BiPH) Q1 2024 focus group. Please use this form to complete your registration. Once complete a final confirmation e-mail and Zoom invite will be sent prior to the focus group meeting which will be held virtually, on Wednesday, January 31st from 7:00pm to 8:30pm est. 
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Name: *
E-mail: *
Title / Job / Organization  *
Please select which race/ethnicity select all that apply: *
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Location: *
Years of service in public health: *
Please self-describe your gender / gender identity:  *
Please self-describe your generation: *
Do you have any questions or comments? 
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