Community Health Improvement Plan
Workshop Registration

Please join us on Thursday, December 15th from 5-7pm at the Ansonia Armory as we finalize the priority areas and working groups for our next 3 year community health improvement plan. Light refreshments will be provided at 5pm and the workshop will begin promptly at 5:30pm.

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* 1. Will you be attending the event?

Yes

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* 2. Please complete all fields

First and Last Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 3. Do you have any food allergies or special dietary restrictions?

Yes

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* 4. Please enter your food allergy or special dietary restriction.

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* 5. If you live in the Valley, please select the city/town/borough where you reside

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* 6. If you are participating as a stakeholder or representative from a Valley business or organization, please enter the business or organization name.

Community Health Improvement Plan Workshop Registration

Question Title

* 1. Will you be attending the event?

Question Title

* 2. Please complete all fields

Question Title

* 3. Do you have any food allergies or special dietary restrictions?

Question Title

* 4. Please enter your food allergy or special dietary restriction.

Question Title

* 5. If you live in the Valley, please select the city/town/borough where you reside

Question Title

* 6. If you are participating as a stakeholder or representative from a Valley business or organization, please enter the business or organization name.

Community Health Improvement Plan
Workshop Registration