SAC PPC Membership Application
We appreciate your organization's interest in joining the Southern AIDS Coalition Public Policy Committee. All Applications are submitted to the PPC for consideration. Please consult the SAC PPC Operating Principles for any questions or contact Alejandro Acosta, Director of Public Policy & Advocacy (alejandro@southernaidscoalition.org).
Organization Name
*
Primary Contact Name
*
First Name
Last Name
E-mail
*
example@example.com
Organization's Phone
*
Format: (000) 000-0000.
Contact's Phone
*
Format: (000) 000-0000.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
Please provide a brief overview of your organization's mission and/or areas of work related to addressing HIV-related public policy in the southern United States.
*
Please share information regarding any policy issues your organization is currently addressing.
*
Membership Type. PPC Members are required to be dues paid members of the Southern AIDS Coalition. If dues are a barrier to your organization's membership, please indicate that in your responses in the application. The required membership dues are based on an org's budget and can be found at: https://southernaidscoalition.org/organizations/
*
Community Based Organization
Government Agency
Corporate/Business
Other
Signature of person authorized to request membership on your organization's behalf.
Signature Date
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Month
-
Day
Year
Date
Apply for Membership
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