Registration

Registration for Community Dialogues

Please fill out the below form to register. Spaces are limited, so please register as soon as possible!

Persons without e-mail or internet access may register by phoning (517) 887 - 4428. Please be sure to state your name, which dialogue you plan to attend, and a good phone number to reach you.

* Indicates required field

Which dialogue would you like to register for? *

Dansville (Tuesday, June 26th: 7-9 pm, 1362 Mason Street-the old fire station) East Lansing (Thursday, June 28th: 1-3 pm, Hannah Community Center-819 Abbot Road) DeWitt (Tuesday, July 10th: 6-8 pm, St. Francis Retreat Center-703 E. Main Street) Eaton Rapids (Thursday, July 12th: 6-8 pm, Eaton Rapids Medical Center-1500 S. Main Street) St. Johns ( Friday, July 13th: 11 am- 1 pm, Clinton Commons-1105 S. Scott Road) Lansing (Tuesday, July 17th: 7-9 pm, Cooley Temple Conference Center-217 S. Capitol Avenue) Charlotte (Thursday, July 19th: 5:30-7:30 pm, AL!VE- 800 W. Lawrence Avenue)

Name *

First

Last

Email Address *

Phone Number *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Special accommodations needed? *

Submit

Once you submit your registration, you will receive an e-mail confirming your registration within 3 days. You will be e-mailed a link to the pdf copy of the Community Health Profile Report for your review -- although you need not have read the report to participate in the dialogue.