GVPHC Membership Enrollment
My Agency wants to join The GVPHC!
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Mental Health Service Organizations
Substance Abuse Service Organizations
Affordable Housing Developer(s)
Public Housing Authorities
Youth Homeless Organizations
School Administrators/Homeless Liaisons
Victim Service Providers
Human Trafficking Survivor Services Agencies
Homeless or Formerly Homeless Person(s)
Street Outreach Team(s)
HIV/AIDS Community Advocates and Service Providers
Elderly and Disables Advocates and Service Providers
Veterans Homeless Service Providers
Nonprofit Homeless Service Providers
Local Government Staff/Official(s)
Executive Director's Name
Additional Agency Contact's Name
I acknowledge that for the above agency to be considered an active GVPHC member, at least one delegate being in the executive or managerial positions, must meet the Bylaws definition of active membership (see Article III).
Electronic Signature: By entering your name above, you acknowledge that all of the above information is true and accurate.
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