COMMUNITY BASED ORGANIZATION PARTNERS

Name

First NameLast Name
Where are you located? *

Street Address

Street Address Line 2

CityState

Zip Code
E-mail
example@example.com
Phone Number

Area CodePhone Number
BUSINESS or INITIATIVE DETAILS

Tell us about your Company, organization or idea
Organization Name
How long has your company or NGO been in existence?

5years+4years3years2years1yearFew monthsStill an idea 💡
What is your organization's mission?
How can CBOP membership help your mission ?
How did you hear about Us?

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What are your core reasons for deciding to join CBOP?

I am Passionate about health equityI want to develop my Leadership CapacityI want to get Business/Grant Funding OpportunitiesI want to learn more about community engaged research to help eliminate racial health disparitiesI want mentorshipI just love the Name - CBOPI want to be part of this FamilyI love to be part of an NGO that helps its member organizations changes lives in the community.
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BUSINESS or INITIATIVE DETAILS