National Health Center Week Form · North Carolina Community Health Center Association

Thank you for sharing information with us about your National Health Center Week event plans. Please fill out this form for EACH EVENT you plan to hold. We will then forward your information to our national organization, NACHC, for listing on their website. We will also provide talking points for health centers to provide to visiting elected officials.

Enter your email address*
Enter your Community Health Center*
Name of Your Event*
Date of the Event*
MM slash DD slash YYYY
Time*
Will Elected Officials be in attendance?*
If Yes, please list who:
Award? Do you plan to give an award to an elected official at this event? Do you plan to give an award to a staff, board, or community member? If so, please describe.*
Event Location Address*
Address 2
City*
State*
ZIP*
Would you like NCCHCA Staff to attend?*
If yes, do you have any special instruction for staff? i.e. bring jogging clothes, bring a camera, bring sunscreen?
Event Description*
Are you Sponsored?*
If Yes, please list name of sponsor
Are you still seeking new or additional sponsorship?
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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