Register for VIRTUAL Chronic Disease Awareness Week! March 3rd: Kickoff event & March 8-12th: Meetings with legislators
Join Coloradans from across the state who are caregivers and/or are living with chronic diseases. This week is hosted by the Chronic Care Collaborative and its 40 member organizations.
Join us March 3rd from Noon-1:30pm to hear from inspiring advocates and learn about 2021 legislation.
The week of March 8th will be a series of opportunities to make your voices heard, including digital advocacy and virtual meetings with legislators as their schedules permit.
By registering you will receive details as the dates gets closer. In order to participate in the legislator meetings, please register by March 1st.
* Required
Email address
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone number
*
Your answer
Address (sharing your address allows us to find your legislators)
*
Your answer
Your connection to Chronic Disease Awareness Week - please list your chronic disease(s), affiliated organization(s), and/or as a caregiver, etc.
Your answer
Is this your first time attending Chronic Disease Awareness Day?
Yes
No
Clear selection
Your story can help improve health policy! What would you most like to share with Colorado state legislators? Have you or a loved one experienced barriers to receiving care? What health care issues are most important to you?
Your answer
Disclaimer: By registering for this event, you agree to allow your name and image that could be captured during a virtual event to potentially be used in the media and communications activities of the Chronic Care Collaborative and its members. If you would like to opt out of being in Chronic Disease Awareness Week photos, please consider options such as having your screen off during a virtual event. Feel free to reach out to CCC staff if you have any questions.
Send me a copy of my responses.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Chronic Care Collaborative.
Report Abuse
Forms
