Organization Registration

Please fill out form with necessary information and click the submit button below.

Organization/Group Name	Buffalo Lake Healthcare Center
Primary Phone	3208335364
Primary Email	activitiesblhcc@gmail.com
Address	P.O. Box 12
Address Ln 2
City	Buffalo Lake
State	Mi
Zip	55314

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

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