SDOH Council Resident Sign-Up — Center for Urban Transformation

5th Ward Resident SDOH Council Sign-Up

Thank you for joining us to discuss the state of health in 5th Ward!

If you are a resident of 5th Ward who is not participating in the meeting as a representative of an organization that also pays you, you are eligible for a $25 gift card for participation.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am a 5th Ward Resident

At these meetings I am not representing a company or organization that compensates me for my time / pays me.

I acknowledge there is a limited amount of funds and I will be notified whether or not I am approved for compensation (first come first served by registration date) by phone and email.

I acknowledge these meetings are by zoom or phone.

I acknowledge that I will receive my compensation by pick-up appointment at 3300 Lyons.

Questions? Requests?

5th Ward Resident SDOH Council Sign-Up

Hours

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Center for Urban Transformation