Black Maternal Health Week Survey - Collecting Plans
1.
First Name
2.
Last Name
3.
Organization
4.
Email Address
5.
Phone Number
*
6.
I/My organization is a member of (check all that apply)
(Required.)
SPA 1 (AV) AAIMM CAT
SPA 2 (San Fernando/Santa Clarita Valley) AAIMM CAT
SPA 3 (Pasadena/San Gabriel Valley) AAIMM CAT
SPA 6/8 (South LA/South Bay) AAIMM CAT
LA County AAIMM Steering Committee
None of the above
7.
What do you have planned during BMHW?
8.
What support do you need?
9.
Would you be interested in collaborating on your event?
10.
Did you have an event/activity planned that had to be cancelled due to “safer at home” orders? If so, please provide detail?
11.
Would you like support thinking through how to make those plans possible virtually?
12.
Would you need assistance accessing technology to deliver an event virtually?
13.
Do you have any blogger/celebrity contacts willing to promote the AAIMM work and Black Maternal Health Week?