Get in touch with Jennie, our Public Health & Wellness Chairwoman!
Please fill in the following information to the best of your ability, and Jennie will be in touch! All fields are required. If a field doesn't apply, please just enter N/A. There are no wrong or instant disqualifying answers, so be as candid as you like. This will give us a clear understanding of what you envision.
Your name
Your answer
Email
Your answer
Phone number
Your answer
Any professional affiliations?
Please let us know if you are representing a company or if you are affiliated with any nonprofit organizations.
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms