Public Meeting Registration Form - Healthy People 2020

Use this form to register to attend public meetings. An asterisk '*' denotes required data.

First Name:

Middle Initial:

Last Name:

Degrees:

Job Title:

Organization/Institution:

Address Line 1:

Address Line 2:

City:

Country:

State/Province:

or Other: *

Zip/Postal Code:

*(for U.S./Canada)

Telephone:

Fax:

E-mail Address:

Organization Category:

or Other: *

Desired Meeting(s):

Prior to onsite registration and for meeting planning purposes only, HHS would like to know the specific topic areas or content areas you will be interested in presenting as an oral public comment. Below, please select up to three topics, in order of preference (first choice, second choice, third choice) that you would like to present an oral public comment. Please note that your pre-selections here do not guarantee an oral public comment slot. Oral public comment registration will be onsite at each meeting location and on a first-come, first serve basis.

View Oral Comment Topic Choices

Would you like to present an oral comment at the public meeting?

YesNo

Accommodation Needs:

How did you hear about the 2009 Healthy People 2020 Public Meetings?

Keep me involved and updated on Healthy People:

By checking this box, you are opting-in to the Healthy People Listserv to receive periodic email updates about Healthy People. We respect your privacy and will not share or give out your email address.

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You may also print and fax this form to: (301) 593-5791