General Membership Form

Membership Criteria

Partnership membership is open to Alexandria community residents, Alexandria service providers, representatives of local organizations, agencies or commissions, faith organizations, Alexandra business owners and anyone else interested in promoting and preserving a healthier Alexandria.

The Partnership for a Healthier Alexandria's eight priority areas for 2014 - 2019, as identified in the Community Health Improvement Plan, are:

Access to Care
Adolescent Health and Well-being
Aging Well in Place
Clean and Smoke Free Air
Healthy Eating and Active Living
HIV/AIDS Prevention Care
Maternal and Child Care
Social Stigma of Mental Illness (Mental Health, including Social Stigmatization)

Name of Individual/Agency/Organization: *This question is required.

I/we agree to serve as an active member of the Partnership for a Healthier Alexandria and agree to do one or more of the following:

Promote improving the health and well-being of people living, working and playing in Alexandria.
Support and/or participate in the implementation of Alexandria's Community Health Improvement Plan.
Support and/or participate in the activities of one or more Partnership priorities.
When possible, provide resources (time, meeting space or funding) to help implement the Alexandria Community Health Improvement Plan.
Participate in the Partnership's semi-annual membership meetings.

Contact Information:

Name: *This question is required.

Position/Title:

Organization/Agency (if possible): *This question is required.

Address:

Phone No.: *This question is required.

Email Address: *This question is required. This question requires a valid email address.

General Membership Form

Detailed Information