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MHA Pledge to Address Racism and Health Inequities

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6. Are you submitting this pledge on behalf of your entire health system or individual hospital? *This question is required.
7. Please provide contact information for the individual who oversees your organization's diversity, equity and inclusion efforts. This individual will be contacted by the MHA regarding the completion of a health equity organizational assessment. *This question is required.
8. If you have an additional contact who oversees your organization's diversity, equity and inclusion or population health efforts, please enter their information below. 
If there are additional staff members at your organization that you wish to have included on MHA communications related to advancing health equity, please email the contact information (name, title, email and phone number) for each person to keystone@mha.org.
A copy of this form will be sent to your email after you click 'Submit'.