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The Council on Black Health hopes that your organization will be actively involved in supporting the Black Health Bill of Rights as a reference point for enabling thoughtful conversations and actions led by collective Black voices in pursuit of health equity for Black Americans. The Black Health Bill of Rights serves as a call to action. Strategic partnerships with researchers, organizations, community leaders, and community members who believe in the fundamental rights to health of Black Americans are vital for arriving at substantive, long-term solutions through joint initiatives, programs, and projects. Reaching the goal of health equity for Black Americans will require engagement of our members, chapters, and partners to serve as a think tank and action platform to realize healthy Black communities. We respect that each organization functions differently, so we ask that you send us the information below so we can communicate effectively with your organization.

Per the Council on Black Health's policies, we WILL NOT accept nor solicit any financial donations, contributions, sponsorships, in-kind gifts, loan of goods, services, partnerships, or endorsements under any condition from any tobacco or alcohol companies, tobacco or alcohol company subsidiaries, or from any companies or company subsidiaries that have engaged in activities that have historically harmed the Black community.

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Our organization supports the Black Health Bill of Rights as a reference point for enabling thoughtful conversations and actions led by collective Black voices in pursuit of health equity for Black Americans. Our organization believes that health equity means justice in all aspects of health, and we join the Council on Black Health in this call to action to recognize, affirm, and take action to ensure the fundamental rights to health for Black Americans.

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* 1. Organization Name

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* 2. Organization Logo (if you would like it included on our website)

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* 3. Organization Address

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* 4. Organization Phone Number

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* 5. Organization Website

The following person will serve as contact person on behalf of our organization to coordinate support for the Black Health Bill of Rights.

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* 6. Authorized Contact Person:

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* 7. Secondary Authorized Contact Person:

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* 8. Please provide initial plans for how your organization intends to use the Black Health Bill of Rights (in addition to endorsement).

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