HYBRID: Community Collaborative Forum Registration: May 5th, 2026

Community

Community Coalition / Collaborative/ Partner / Non-Profit / For-Profit / Philanthropy
What organization are you representing?*
What services do you provide?*
Zip Codes You Serve*

Event Sponsors
What organization are you representing?*
What Zip Codes do you serve?*
Yes, I would like a tableNo Table, but I would like to set out materialsNo, Thank You

Tribal Officials and Representatives
Please select your Tribe, Nation or Pueblo*
Please describe your role (i.e. Tribal President, Tribal Governor, Tribal Chairs, Elder, Member, etc)?*

Media Release Form
I, *

First NameLast Name
grant permission to New Mexico Alliance of Health Councils (NMAHC) to use my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed and I hereby waive any right to inspect or approve the finished product(s) now or in the future, and I waive any right to royalties or other compensation arising from or related to the use of the image. By signing this release, I acknowledge that I have completely read and fully understand and agree to the terms of this release.*
Date*

MonthDayYear
Date
I am over the age of 18I am NOT over the age of 18
Signature of parents or legal guardian:
Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Community Collaborative Forum