JUMPP Task Force

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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* 1. Prefix

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* 2. Please provide

First Name

Last Name

Job Title

Organization Name

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* 3. Organization Type

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

Develop joint/shared use policies/agreements/practices

Implement joint/shared use policies/agreements/practices

Develop reources to support joint/shared use e.g. briefs, tookits

Provide training and/or technical assistance to support joint/shared use

Advocate for joint/shared use

Mobilize residents to advocate for joint/shared use policies agreements/practices

Provide programming at joint/shared use sites

Identify potential sites/organizations for joint/shared use policies/agreements/practices

Other (please specify)

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* 5. Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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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

Work

Cell

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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)

Operations Workgroup

Communication Workgroup

Funding Workgroup

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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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* 1. Prefix

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* 2. Please provide

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* 3. Organization Type

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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)

Question Title

* 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)