Health Equity Community Advisory Board
Registration Information
* Required fields
*
First name:
*
Last name:
*
Email:
*
Phone number:
*
Home ZIP code:
*
Age:
*
Member ID (can be found on your IBX member ID card):
*
Health plan (can be found on your IBX Member ID card):
*
Will you be able to attend meetings in person at 1901 Market St. Philadelphia PA 19103?
Yes
No
*
Do you require any accommodations to make attending meetings accessible for you?
Yes
No
If yes, please elaborate:
Please tell us something about you that will help us understand your interest in the CAB.
