Thank you for your interest in the Bronx Health & Housing Consortium! If you wish to become a member of the Consortium, please complete this member profile and an invoice will be sent to the billing contact provided. 

If you are already a member, please fill this out so we have the most up-to-date information. 

Contact tsommer@bxconsortium.org with any questions. 

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* 1. Name of Organization:

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* 2. Is this organization non-profit or for-profit?

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* 3. Why is your organization interested in being a member of the Consortium? What would be helpful to your organization and staff?

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* 4. Your organization is a (check all that apply):

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* 5. In which geographic areas does your organization operate? (check all that apply)

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* 6. What types of services does your organization provide? (check all that apply)

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* 7. Number of Staff:

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* 8. Annual Organizational Budget:

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* 9. Designated contact person for membership and billing related matters:

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* 10. Designate a main contact person for program related issues and registering staff for Consortium events and trainings:

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* 11. Designate a secondary contact person for program related issues and registering staff for Consortium events and trainings:

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* 12. Any additional staff from your organization you would like to be added to our mailing list

You may also send a spreadsheet to tsommer@bxconsortium.org with  names, job titles, and email addresses for all staff you would like added to our mailing list. There is no limit on the number of people you can add.

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