Participant Registration Form2025 Mississippi Maternal Health Conference (September 12, 2025)

Your Name (First and Last Name)

Your Email Address

Name of Organization

Which CEUs would you need for attending this conference?

Nurse

Certified Health Education Specialist (CHES)

Social Worker

I Do Not Need CEUs

If CEUs are needed, please provide your license/certification number below (if known):

Would you like to attend the maternal health CEAL "Fireside Chat" session from 8:00 AM - 9:00 AM?

Note: The Community Engagement Alliance (CEAL) Focus Area 2 Project is an initiative aimed to enhance cardiovascular and maternal health outcomes for young Black women aged 25-45.

Yes

No

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