Submitted by Matthew Diener on

HEALTH FORUM INC.
California Consumer Privacy Act Request Form

(Including Do Not Sell/Share Personal Information)

FOR CALIFORNIA CONSUMERS ONLY

California consumers may submit this form to Health Forum Inc. to exercise their rights under the California Consumer Privacy Act (CCPA). The CCPA affords California consumers (collectively 鈥渃onsumer鈥 鈥測ou鈥 鈥測ours鈥) the following rights with respect to their personal information to: (1) Right to opt-out the sale or sharing of your personal information; (2) Right to know (access) your personal information; (3) Right to correct your personal information; (4) Right to Limit Sensitive Personal Information (Vendors Only); and (5) Right to delete your personal information. For more information about Health Forum Inc.鈥檚 (collectively, 鈥淗ealth Forum鈥, 鈥渨e鈥, 鈥渦s鈥 or 鈥渙ur鈥). Please visit the AHA Privacy Policy, Privacy Notice for California Residents for more information about personal information Health Forum Inc. collects from you and our privacy practices.

Please indicate your relationship(s) with Health Forum Inc. (Please select all that apply.)
Please indicate your interaction(s) with Health Forum Inc. (Please select all that apply.)
Select the Right you Want to Exercise. (Please make one selection at a time.)
(1) Specific pieces of personal information collected about the consumer; (2) Categories of personal information collected about the consumer; (3) Categories of sources from which the personal information is consumer; (4) Categories of personal information we have sold or disclosed for a business purpose about the consumer; (5) Categories of third parties to whom the personal information was sold or disclosed for a business purpose; and (6) The business or commercial purpose for collecting or selling personal information.
We collect bank account and social security numbers from service providers and contractors.
(Please note that deleting all your information may result in the consumer not receiving communications from AHA. If you are requesting to delete only a part of your personal information, please set which information you are requesting to delete below).
California Consumer Information (Please complete all fields.)
Select How You Would Like to Receive Information. (Please select one.)

Health Forum Inc. will use this form to verify your identity to complete your request. We reserve the right to request additional information to verify your identity or to complete your request. Please submit one type of request at a time.

If you have questions about this webform please contact us at compliance@aha.org. If you would like to submit your request over the telephone, please contact us at our toll-free number at 1-800-424-4301.

If you are an authorized agent submitting this request, please complete this form, print out a copy and email this form with your power of attorney or signed authorization from the California consumer to us at compliance@aha.org. We may contact the California consumer to authenticate this request and verify your authority.