Contact Information

To help us process your membership application, please provide all of the information requested. Enter N/A (not applicable) where appropriate. If you need assistance in filling out this application, please contact the planning council support office at 410-396-1646.

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* 1. Contact Information:

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* 2. Current Place of Employment (if applicable):

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* 3. Information can be sent via email at any time to the Planning Council support office at Jocelyn.Stenhouse@baltimorecity.gov.

If applicable, please provide your preferred email below:

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* 4. Please select your county of residence and/or employment from the list below:

Please be aware that the Greater Baltimore HIV Health Services Planning Council (planning council) is a public body. The planning council will be contacting you via mail, e-mail and/or telephone. Please tell us how you prefer to be contacted:

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* 5. Preferred method of contact:

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* 6. I prefer to receive written correspondence at:

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* 7. I prefer to receive phone calls and messages at:

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