Shape Up SF Membership Agreement

Thank you for your interest in joining the Shape Up San Francisco Coalition. By completing this membership agreement, you confirm your support for the Coalition and its priorities to: increase access to healthy foods, increase opportunities for physical activity and decrease consumption of sugary drinks in order to make the healthy choice the easy choice. Further, you are agreeing to attend quarterly membership meetings and actively participate in Coalition activities and events.

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* 1. Please provide the following:

Name: *

Agency Affiliation (if any)

Email Address: *

Phone Number:

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* 2. Check all that apply. I am a(n):

Community leader or advocate

Youth advocate

Interested community member

Public Health Dept/City Agency Employee

Health Professional

Community-based agency employee

Other (please specify)

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* 3. I am affiliated with a(n):

Health Agency

Media/Public Relations

Non-profit agency

Workplace

Educational Institution

Government Agency

Community-based organization

Ethnically-focused organization

Faith community

Senior service

Voluntary health organization

Youth service organization

Other (please specify)

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* 4. How did you hear about the Shape Up SF Coalition?

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* 5. Why do you want to participate in the Coalition?

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* 6. In which neighborhoods does your organization have programs? (If not affiliated with an organization, in which neighborhood do you live?)

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* 7. The Shape Up SF Coalition’s three priorities are to: increase access to healthy food; increase opportunities for physical activity; and decrease consumption of sugary drinks. Which of the three strategies is your priority? (Check all that apply)

Increase access to healthy food

Increase opportunities for physical activity

Decrease consumption of sugary drinks

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* 8. How you would like to participate in the Coalition?

Information sharing/networking

Expand advocacy for policies to increase access for healthy food, opportunities for physical activity or decrease consumption of sugary drinks

Testimony at policy hearings

Action alert network

Media advocacy, including writing letters to editors, acting a spokesperson

Other (please specify)

Thank you for providing the information about your interests and commitment to the Shape Up SF Coalition.

Membership is free and open to individuals and organizations that have an interest in healthy eating and active living. By submitting this membership agreement, you will become a Shape Up SF Coalition member and are committed to the mission of the Coalition, can express your opinions and participate in Coalition decisions by attending Coalition meetings or serving on task forces or committees. You agree to abide by the mission of the Coalition and will act in the best interest of the Coalition. You will abide by decisions made at any Coalition meetings even if you were unable to attend.

The Mission of the Shape Up SF Coalition is: To convene partners for greater collective impact in order to create equitable and sustainable environments, systems and policies that promote healthy eating and active living across the lifespan in San Francisco.