ACEMAPP Communities Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

ACEMAPP Communities Registration

By completing this form, you understand that your organization's subscription fee will increase by $600/year.

Sign in to Google to save your progress. Learn more

* Indicates required question

Email *

Your email

How would you like your Communities' name to appear in ACEMAPP? *

Your answer

From which organization's ACEMAPP account would you like to funnel people into your Communities account? *

If you have a health system account set up in ACEMAPP, you can just name this account. If you do not use a health system account, please list the clinical site accounts in ACEMAPP that should be connected.

Your answer

Next

Clear form

Never submit passwords through Google Forms.

This form was created inside of Michigan Health Council. Report Abuse