SFHP Member Advisory Committee (MAC)
Application Form

All fields required unless otherwise specified.

Fill out this form to join the MAC meetings starting in 2024.

First Name: Please enter text only

Last Name: Please enter text only

Address:

Phone Number: Please enter a valid phone number

Email: Please enter valid e-mail address.

Please choose the program you or a family member has:

Medi-Cal

Healthy Workers HMO

Not an SFHP Member

Other Public Health Program:

What language do you speak?

English

Spanish

Chinese

Other:

Please tell us why you want to join the MAC?

If you are not currently an SFHP member, please tell us more about you and your work with SFHP members and San Francisco community.

Where do you work? (Optional for SFHP members)

Please describe your role, what you do, and how you work with SFHP members or the San Francisco community.

I want to join the MAC. I agree to attend four MAC meetings in-person a year. I will share my ideas and concerns at each meeting. My feedback helps SFHP provide good care for members.

SFHP Member Advisory Committee (MAC) Application Form