CSHNB Town Hall Registration Form
December 5, 2025 10:00am-12:00pm
Hawaii Island Community Health Center (HICHC) Pavilion 74-5214 Keanalehu Dr., Kailua Kona, HI
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Agency and/or Position:
Food Allergies
Snacks and Refreshments will be provided
How will you participate?
Please Select
I plan to join in-person
I can only attend virtually and will need a meeting link
In-person attendance is highly encouraged
Interpreter Needed?
Please Select
Yes
No
If yes, please enter preferred language below
Preferred language if you are requesting an interpreter (if none, enter n/a):
Submit
Should be Empty: