Community Advisory Board (CAB) Member Form

First Name*:

Last name*:

Gender*:

• Male
• Female
• Transgender

Age*:

Email*:

Phone Number*:

Preferred method of contact:

• Phone
• Email

Please tell us about any skills or previous experience that you can contribute to the CAB.

How did you find out about our CAB?

• Project ACHIEVE Website
• Project ACHIEVE Facebook Page
• Columbia University Medical Center Facebook Page
• A current CAB member
• At an event
• Other

Please confirm: