Eat Smart, Move More NC - Organization Membership Application

The mission of Eat Smart, Move More NC is to reverse the rising tide of obesity and chronic disease among North Carolinians by helping them to eat smart, move more and achieve a healthy weight. Eat Smart, Move More NC works to change policies, practices and environments to make eating smart and moving more possible for all North Carolinians.

To apply for membership for your organization to become a new member or to update your organization's membership information, complete this form and submit.
Organization Information

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* 1. Organization Information

Organization Mission Statement:

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* 2. Organization Mission Statement:

Organization Web site:

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* 3. Organization Web site:

Organization's Representative or Primary Contact Person

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* 4. Organization's Representative or Primary Contact Person

Type of Organization Entity (check one)

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* 5. Type of Organization Entity (check one)

Type of setting in which this organization actively supports policies and practices to help people eat smart and move more (check all that apply)

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* 6. Type of setting in which this organization actively supports policies and practices to help people eat smart and move more (check all that apply)

Are there additional people in your organization you wish to be added to the Eat Smart, Move More NC email list-serve?

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* 7. Are there additional people in your organization you wish to be added to the Eat Smart, Move More NC email list-serve?

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