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Agency Name*:	Allegan County Health Department Barry-Eaton District Health Department Bay County Health Department Benzie-Leelanau District Health Department Berrien County Health Department Branch-Hillsdale-St. Joseph Community Health Agency Calhoun County Department of Public Health Central Michigan District Health Department Chippewa County Health Department Department of Environmental Quality Dickinson-Iron District Health Department District Health Department No. 10 District Health Department No. 2 District Health Department No. 4 DTMB Genesee County Health Department Grand Traverse County Health Department Health Department of Northwest Michigan Huron County Health Department Ingham County Health Department Ionia County Health Department Jackson County Health Department Kalamazoo County Health and Community Services Kent County Health Department Lapeer County Health Department Lenawee County Health Department Livingston County Department of Public Health Luce-Mackinac-Alger-Schoolcraft District Health Department Macomb County Health Department Marquette County Health Department Michigan State University - Geography Mid-Michigan District Health Department Midland County Department of Public Health Monroe County Health Department Muskegon County Health Department Oakland County Health Division Ottawa County Health Department Public Health Delta & Menominee Counties Saginaw County Department of Public Health Sanilac County Health Department Shiawassee County Health Department St. Clair County Health Department State of Michigan Tuscola County Health Department Van Buren/Cass County District Public Health Department Washtenaw County Department of Planning & Environment Wayne County Health Department Western Upper Peninsula District	Email:
Address*:		Phone Number*:
City*:		Fax Number:
County*:	Alcona Alger Allegan Alpena Antrim Arenac Baraga Barry Bay Benzie Berrien Branch Calhoun Cass Charlevoix Cheboygan Chippewa Clare Clinton Crawford Delta Dickinson Eaton Emmet Genesee Gladwin Gogebic Grand Traverse Gratiot Hillsdale Houghton Huron Ingham Ionia Iosco Iron Isabella Jackson Kalamazoo Kalkaska Kent Keweenaw Lake Lapeer Leelanau Lenawee Livingston Luce Mackinac Macomb Manistee Marquette Mason Mecosta Menominee Midland Missaukee Monroe Montcalm Montmorency Muskegon Newaygo Oakland Oceana Ogemaw Ontonagon Osceola Oscoda Otsego Ottawa Presque Isle Roscommon Saginaw Sanilac Schoolcraft Shiawassee St. Clair St. Joseph Tuscola Van Buren Washtenaw Wayne Wexford	License Num.*:
State*:	AK AL AR AZ CA CN CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA RI SC SD TN TX UT VA VI VT WA WI WV WY Zip*:

I Need Access to the Following Counties:   Click here to select. ctl00_ContentPlaceholderMain_ddmsCounties_hiddenPopup1,ctl00_ContentPlaceholderMain_ddmsCounties_EditImage ctl00_ContentPlaceholderMain_ddmsCounties_hiddenPopup2 ctl00_ContentPlaceholderMain_ddmsCounties_hiddenPopup1,ctl00_ContentPlaceholderMain_ddmsCounties_EditImage   ctl00_ContentPlaceholderMain_ddmsCounties_hiddenOriginalRemarks Alcona Alger Allegan Alpena Antrim Arenac Baraga Barry Bay Benzie Berrien Branch Calhoun Cass Charlevoix Cheboygan Chippewa Clare Clinton Crawford Delta Dickinson Eaton Emmet Genesee Gladwin Gogebic Grand Traverse Gratiot Hillsdale Houghton Huron Ingham Ionia Iosco Iron Isabella Jackson Kalamazoo Kalkaska Kent Keweenaw Lake Lapeer Leelanau Lenawee Livingston Luce Mackinac Macomb Manistee Marquette Mason Mecosta Menominee Midland Missaukee Monroe Montcalm Montmorency Muskegon Newaygo Oakland Oceana Ogemaw Ontonagon Osceola Oscoda Otsego Ottawa Presque Isle Roscommon Saginaw Sanilac Schoolcraft Shiawassee St. Clair St. Joseph Tuscola Van Buren Washtenaw Wayne Wexford   ctl00_ContentPlaceholderMain_ddmsCounties_ValuesLabel ctl00_ContentPlaceholderMain_ddmsCounties_lstData ctl00_ContentPlaceholderMain_ddmsCounties_hiddenSection ctl00_ContentPlaceholderMain_ddmsCounties_hiddenLink ctl00_ContentPlaceholderMain_ddmsCounties_RemarksTextBox (Use Ctrl+Click to select multiple items)
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