Photo Credit: Olga Lopez
 
What is BHC?
Vision Statement
Membership Form
 

BHC Network Membership Information Form

Please complete the form below to join the BHC Network.

* - Required fields

Name*:
Organization*:
Address*:
City*: State*:
Zip Code*: Email:
Phone*: Fax:
Web Address:

 Yes! I would like to join the BHC Network.

My organization endorses the BHC Vision Statement and is actively working on the following programs or public policy/advocacy efforts:

Program name:

Brief description of purpose/goals:

Who is served?

Who is involved?

Are you collaborating with other organizations? Yes    No

How long has the effort been underway?

What successes have you achieved so far?

What were your biggest challenges in getting started?

What were your biggest challenges in achieving results?

How did you overcome them?

Are you willing to share your story with others?
in writing?
by phone as part of the Building Healthier Communities referral network?

What local, state and federal issues are important to you?

Are you actively working on any of these? Yes    No

What have your successes and challenges been so far?

Please click submit to join the BHC Network.