SHEC Expert Stakeholder Partnership Form
First Name
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Last Name
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Position/Title
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Organization
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Email Address
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Phone Number
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Mailing Address
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City
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State
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Zip Code
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1. Sectors / populations that you serve and / or represent (check all that apply)
2. Please indicate your areas of expertise below. (check all that apply)
3. How would you like to get involved with SHEC activities? (check all that apply)
Awareness Committee:
Cultural Competence Committee:
Social Determinants of Health Committee:
General:
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