Please complete the form below to register as a member of the California Adult Immunization Coalition.   Name Title Organization Address City State Zipcode   Phone Fax   Email Address         Please check all of the boxes below that best describe your level and areas of interest:     Receiving newsletters / updates from CAlC Attending CAlC Steering Committee Meetings   Participating on a work group. If yes, please check your areas of interest from the items below:     Quality Improvement Long Term Care Acute Care/Hospital Based Communications Health Care Worker Provider Focused Policy Vaccine Distribution Community Focused   Other         top   © 2005 California Adult Immunization Coalition