IMPACT Interest Form
Thanks for your interest in IMPACT. Please share your contact details and a bit more about your interest and we will be in touch!

IMPACT membership is open annually each summer. Interested groups will be emailed at the start of the next membership joining period with an invite to move forward in the membership process at that time.
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What's your name?
What's your email?
What organization are you with?
How did you learn about IMPACT?
Tell us a bit about your work in Virtual First Care.
Thanks for your interest in IMPACT! We will be in touch when the next membership application period opens in the Summer. In the meantime, you can sign up to follow our work through our monthly newsletter at http://impact.dimesociety.org/resources/#newsletters.
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