Healthy Homes Community Sign-Up Form

Healthy Homes Community Action Group Sign-Up Form
Thank you for your interest in being part of a resident-led effort to shape the future of your neighborhood. We’re bringing neighbors together to take action, build solutions, and drive lasting change and we are so gald that you are here. Please take a few moments to share your information in this form. We will be in touch with you within 24-48 hours with more information.
Full Name

First NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I give permission to receive SMS messages about meeting updates, resources, and activities.
Are you attending the Healthy Homes Community Action Group Kickoff event Monday, June 15 at 6:30 PM (LOCATION TBD)
Do you need childcare at meetings?
Do you have any barriers to transportation? or mobility?
Should be Empty:

Healthy Homes Community Action Group Sign-Up Form