Communities of Connection: Interest Form

Communities of Connection: Interest Form

Thank you for your interest in Communities of Connection! Please fill out this form to express your interest in receiving resources about women's heart health risks and/or heart health advocacy in your city. Your responses will help us provide you with the best resources and experience possible.
Name*

First NameLast Name
Email*
example@example.com
Organization (if applicable)
City*

Kansas CityNew YorkPhoenixWashington D.C.
How are you interested in engaging with Communities of Connection? (Check all that apply)*

I would like to receive resources about women's heart healthI'm interested in receiving more information about how to advocate for women's heart healthI would like a WomenHeart Champion to present to my organization or communityOther (please elaborate below)
Do you have any additional comments or questions?
How did you hear about Communities of Connection?*

WomenHeart ChampionSocial mediaWomenHeart websiteEmail/NewsletterOther
Let's stay in touch!

I would like to subscribe to get regular updates and resources for heart-healthy living.
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