Become An Endorser

    Name of Organization:*

    Primary Contact

    Name:*

    Title:*

    E-mail:*

    Web URL:

    Phone Number:*

    Alternate Contact (optional)

    Name:

    Title:

    Email:

    Phone Number:

    As an authorized representative of the above listed organization, I have read and endorse the Communities on the Move Declaration.

    I agree to have the name of this organization publicly listed as an endorser of the declaration.

    captcha

    Subscribe to BCAHL Newsletters

    Stay Updated on Health Promotion News