Patient/Family Advisory Committee Membership Application

Thank you for your interest in the Patient/Family Advisory Committee. Membership on the Committee requires successful completion of the registration process, including: formal interviews as well as a mandatory volunteer orientation. All of your information will be treated as confidential. Membership on this Committee requires attendance at monthly Committee meetings and possible participation on other committees of your choice.

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Please indicate which service you or your family members have used at either hospital.







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Have you been convicted of a felony or misdemeanor?
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