Membership Form
for organization representatives and unaffiliated individuals

Background
The JUMPP Task Force is a collaborative of school, park, health, faith, for-profit, and community based organizations working together with a common mission of encouraging community partnerships to activate safe spaces for families to play, learn, and be well in Los Angeles County. JUMPP's priority is to foster equitable access to safe physical activity spaces for all families in park-poor areas of Los Angeles County, and focuses on maximizing the use of existing community resources.

Membership
JUMPP membership is open to all individuals and organizations committed to creating access to safe spaces for physical activity and other health promoting activities.
Membership is an excellent way to stay informed and help shape this work in Los Angeles County. Membership provides access to JUMPP's networking platform, key local joint/shared use information, and local resources to assist members in facilitating Los Angeles County joint/shared use policies, agreements, and practices.

Become a JUMPP Task Force member today by completing this form.

Email JUMPP@ph.lacounty.gov for any questions.

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* 2. Please provide

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* 4. Organization Goals:  (Check all which apply)

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* 5. Address

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* 6. E-mail

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* 7. Please provide the URL you would like to have linked to your Organizations name on the JUMPP Web Site.

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* 8. Phone Numbers

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* 9. The JUMPP Task Force requests that all members actively participate in a JUMPP Workgroup.
Participation can be in-person, via phone, or by email. Please select the Workgroup you would like to join, and you will be added to that  group's email list: (check all that apply)

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* 10. By becoming a JUMPP Member, I agree to allow JUMPP to list my name and contact information on the JUMPP Directory, consent to having my photo taken while participating in JUMPP related activities, and agree to release these images to JUMPP for use in JUMPP outreach materials. Please include your Initials below

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