Event Sign Up Form – The Community Health Center Of Lubbock

Event Sign Up Form

Name *

First

Last

Phone *

Email *

Which class are you interested in? *

Preferred Class Date *

Are you a CHCL patient?

How did you hear about us? (optional)

We appreciate you taking the time to answer this optional question.

Message

If you have an emergency, always remember to call 9-1-1

Chinese (Simplified)

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