Membership Form

The Consumer Advisory Council (CAC) is the primary source of consumer input to the Shiawassee Health & Wellness (SHW) Board of Directors related to the development and implementation of Medicaid specialty services and supports and coordinating agency requirements in Shiawassee County. The CAC includes consumers or guardians.
 
WE NEED YOUR VOICE!
MEMBERSHIP IS RENEWED ANNUALLY - JANUARY 1 TO DECEMBER 31
 
I have read the CAC Charter, acknowledge and agree to participate in the responsibilities and duties of the CAC.
 
Please complete the form below. * required fields

* Full Name

* Phone Number (required)

* Address (required)

* Email (required)

* Signature (Please sign in the box using your mouse, below.)

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