Join the Take Heart Alaska Coalition

Please complete the following form to express your interest in joining the coalition.

* Name:

* Contact Information:

* Work-related Information:

For information on the committees and subcommittees goals and projects, go to the Take Heart Alaska website.

* Take Heart Alaska Committees:

* Treatment and Secondary Prevention Subcommittees:

* Tell us a little about your background and how you plan to contribute to the coalition:

* Can we publish your name as a member of the Take Heart Alaska Coalition on the website?

* How did you hear about Take Heart Alaska?