Section 1 of 1 in this document
Office of Health Care Ombudsman and Bill of Rights
(OHCOBR)
Event Participation Request
Complete this form to submit a request for members from the OHCOBR to participate in your event.
Organization/Agency Name
*
Point of Contact Name
*
Phone Number
Email
*
Date and Time of Event
Anticipated Attendance
Description of Event
*
Event Address
Address or Location
Address Suite/Room Number (if applicable)
Additional Comments
Upload File(s)
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