Health Equity Taskforce Interest Form
Thank you for your interest in the Health Equity Taskforce. 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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First and Last 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.
Which subgroup are you interested in? *
Required
How did you hear about CPQCC?
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