Share your story about your health, a family members health, and or a general health issue with the Illinois Maternal & Child Health Coalition!

 Please take this moment to provide us with your current contact information.
 

 

 

 

 

FIRST NAME:         

LAST NAME:           

 

ADDRESS:                 

CITY:                          

STATE:                       

ZIP CODE:                 

PHONE:                      

EMAIL:                      

 

YOUR STORY:         

 

  •   Please contact me about sharing this story with the media, publishing it on the website or in print and/or speaking at an event. 

  •   This is for the IMCHC’s information only.

     

    Thank you for your time!