State Health Services Council Online Registration

Online registration to present is not required but is welcomed. Please complete the online registration form and submit. If you have handouts for the Council members, please bring 15 copies and deliver them to the registration desk when you arrive for the meeting. Comment time is limited to three minutes per speaker.

Please complete all fields.

Name:

Representing (Name of Facility, Agency, Organization, Business, Self):

Mailing Address:

City:

State:

Zip Code:

E-mail Address:

Phone Number:

I wish to appear before the State Health Services Council at the June 12, 2013 – Work Session June 13, 2013 – Council Meeting Aug. 28, 2013 – Work Session Aug. 29, 2013 – Council Meeting Nov. 20, 2013 – Work Session Nov. 21, 2013 – Council Meeting

Topic or Agenda Item:

My comments will: