Audio Conference Request Form
“
Our mission is to expand the traditional methods of receiving health related services and information in health professional shortage and areas geographically isolated across Northern Michigan
”
Please fill out form with as much information as possible.
Once received REMEC will contact you to confirm your request.
Title of meeting
:
Date of meeting
:
<
January 2012
>
Sun
Mon
Tue
Wed
Thu
Fri
Sat
25
26
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
Time of meeting
Number of callers
:
Person Requesting Meeting
:
email
:
phone:
Person Facilitating Meeting:
email
:
phone:
Meeting location if applicable:
Other information