Town Hall & Professional Open Forum Moderator

Report to the Board of Directors

Complete this form to provide a summary of your town hall meeting.

"*" indicates required fields

Primary Facilitator Name*

First Last

Primary Facilitator Email*

Facilitator 2 Name*

First Last

Facilitator 2 Email*

Facilitator 3 Name*

First Last

Facilitator 3 Email*

Facilitator 4 Name*

First Last

Facilitator 4 Email*

Name of Town Hall or Professional Open Forum Group:*

Number of Attendees:*

General Summary of the Meeting:*

Were there any "hot topics" discussed?*

Were there any concerns voiced by attendees that you would like to share with the APHON Board of Directors?*

Phone

This field is for validation purposes and should be left unchanged.