Board of Managers Meetings Sign-In Form

Sign-In to Speak

All fields with * are required.

Name/Nombre(Required)

First

Last

Preferred Language/Idioma Preferido(Required)

Organization / Organización

Write resident if speaking only for yourself / Indique habitante si se representa a sí mismo.

Address/Domicilio(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Email/Correo Electrónico

PhonePhone/Teléfono(Required)

A Central Health staff member will contact you the day of the meeting to verify you wish to speak. / Un miembro del personal de Central Health se comunicará con usted el día de la reunión para verificar que desea hablar.

At which meeting do you wish to speak? / ¿En qué reunión desea hablar?(Required)

If you selected other, please specify/Favor de especificar

Please specify the meeting during which you wish to speak. Favor de especificar la reunión en la cuál desea hablar.

Will you attend in person or virtually? / ¿Asistirás en persona o virtualmente?(Required)

In Person / En persona

Virtually / Virtualmente

This field is for validation purposes and should be left unchanged.

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Finance

DATA & REPORTS

HEALTH CENTER PLANNING

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Meeting Sign-In

Board of Managers Public Communications Sign-Up Form

Sign-In to Speak