MAC Interest Form

Member Advisory Council Interest Form

Full Name

Mobile Number

Zip Code

Best days/times to reach me:

I am a:

Current Louisiana Healthcare Connections member.
An authorized representative of a current Louisiana Healthcare Connections member.

If I join the Member Advisory Council, I will agree to:

Attend four (4) one-hour virtual meetings.
Be willing to share feedback on my member experience and ideas for improvement.
Be respectful of other council members' opinions and experiences.
Share news about upcoming health and wellness events with family, friends, and others in my community.

(Optional) I have a question about the council or other comment to share:

Name

Mobile Phone Number