StopFalls Network California (Join Us)

Full Name
Organization
Email Address
Phone Number
Street Address
City
State
Zip Code
Subject
Committee Interest

I am interested in serving on the StopFalls Network Planning Committee.

Workgroup/subcommittee interests:

Policy and Regulation
Continuing Education
Resource Exchange
Media
Rural Areas
Urban Areas
Data and Surveillance
Frail Elders
Other:

Communication

I prefer that Future StopFalls Network meetings be held (check all that apply):

In Person
Via Teleconference
Via Video/Web Conferencing Technology

Between meetings, I'd like to stay informed of StopFalls Network activities through (check all that apply):

Bulletin Board
List Serve
Newsletter
StopFalls Website (www.stopfalls.org)

Additional Comments

 

© 2005 Fall Prevention Center of Excellence
This program is made possible through the generous support of the Archstone Foundation
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