Wednesday, February 08, 2012
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Would you like to Join Us, to make Sampson County HEALTHY?
Title:
Dr.
Mr.
Mrs.
Ms.
First Name:
Last Name:
How did you hear about us?
Referral from Somebody
Saw our Office
Internet Search
Mailed Letter/Flyer
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Saw us at an Event
Health Interest:
Heart Disease
Diabetes
Physical Activity
Nutrition
Tobacco
Mailing Address:
City/Community:
State:
Zip Code:
Phone Number:
Email Address:
Participant's Interest/Commitment
Attend Monthly Meeting
Serve on Healthy Carolinians committees/subcommittees
Provide Administrative Support
Create Community Awareness
Represent Healthy Carolinians at Community Events
Assist with planning activities, i.e. identification of resources, implementation of activities
Other Interests, please list:
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July 27, 2010 Minutes
June 22, 2010 Minutes
October 2010
September 2010
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