Health People, Healthy North
teepee
Click Here To Join

25 * Name
1 1
27 * Mailing address
1 1
32 Email address
1
28 * Home phone number
1 1
29 Work phone number
1
30 Cellular phone number
1
31 * Preferred contact method  Home phone
 Work phone
 Cellular phone
 Email

3 1
34 * What community do you belong to? (Example: Gillam)
1 1
35 How long have you lived in that community?
1
36 * Gender  Female
 Male
 Other

3 1
38 * Age Range  Under 18
 18 - 24
 25 - 39
 40 - 54
 55 - 70
 70+

3 1
41 * What language(s) do you speak?  English
 French
 Other

3 1
42 For other, please list
1
44 Diversity is important to us. Please let us know if you are a member of either of these groups.  Indigenous
 Visible minority
 Person with a disability

4
45 What is your primary employment status?
2
46 Please describe your work experience? (paid, unpaid or volunteer)
5
59 Tell us about why you want to join a LHIG?
5
49 Are there any particular health system topics you would like to see discussed by the LHIG?
5
51 Tell us about any groups or team projects you have been a part of?
5
52 How did you hear about the LHIGs?  Newspaper
 Radio
 www.Manitoba.ca
 Brochure
 Word of mouth
 www.northernhealthregion.ca

4
53 If other, please explain
1


 
Facebook TWITTER