National Health Center Week 2015: Add Your Event



Please fill out the form below for each event your health center plans to host. 

To edit event information once you have submitted it, please contact Kate Graetzer at kgraetzer@chcanys.org or 518-434-1115.
Event Name
Date Event Begins
Date Event Ends
Health Center Name
Time Event Begins
Time Event Ends
Name of Event Location
Address of Event Location
Event Location Phone Number
First Name of Event Coordinator
Last Name of Event Coordinator
Event Coordinator Phone
Event Coordinator E-mail
Additional Information about the event
Name of Individual Completing this form
Phone number of person completing form

 

Please press the submit button at bottom of page. You will receive a confirmation message shortly.

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move