PQIP Subcommittee Interest Form
Thank you for your interest in Perinatal Quality Improvement Panel (PQIP) subcommittee membership. Please complete the following and our team will follow up with next steps.

Please email any questions to info@cpqcc.org. Thank you.
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Name *
Email *
Job Title/Role *
Required
Hospital Affiliation (or other affiliation) *
Do you have volunteer experience with a non-profit? *
If yes, please list which organizations and your role.
How did you hear about CPQCC? *
Which subcommittee are you interested in? *
Please check all you are interested in joining.
Required
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