Baldrige Requests

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Please describe your request (please be specific and include reason for the request topic, length, etc.)?
Want to know more about Heartland Health? Get connected to Heartland Health at www.heartland-health.com or www.healthychoiceshealthylives.com. Contact Us Speaker, Consulting and Sharing Days Requests Monica Ray Quality and Safety Process Leader 800-447-6882 baldrige@heartland-health.com Media Requests Marcy George Media Relations and Communications Coordinator 800-447-6882 baldrige@heartland-health.com Talk to us online on Facebook and Twitter.
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Your Name: *
Name of Organization: *
Web site:
City/Province: *
State:
Country:
Phone Number:
E-mail Address:
Type of request: *	Article Interview Speaking Engagement Other If Other, please specify:
Date of event:
Location:
Audience size:
Is your organization on the Baldrige journey? *	Yes No Other If Other, please specify:
Is your organization willing to share best practices as a learning tool for Heartland Health? *	Yes No
If so, Are all expenses paid in full (travel, lodging, meals, etc…)? *	Yes No Other If Other, please specify:
Will you be paying an honorarium (all proceeds donated to Heartland Foundation to help support health improvement in our community)? *	Yes No Other If Other, please specify:
Comments or Questions: