APPEAL · Phoenix Equity Group Membership Form

Member Contact Information

The Phoenix Equity Group includes public health professionals, scientists, and community advocates who are committed to accelerating the process of advancing and achieving health equity. If you'd like to join us, please complete the form below.

Name

First Name

Last Name

Organization

Title or Position

Email

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Areas of Interest

Please indicate the Phoenix Equity Group focus areas in which you are interested.

Funding Resources

Leadership and Capacity Building

Outreach to States and Mainstream Organizations

Accountability, Public Disclosure, and Transparency

Research and Data

Referals

Please provide the name and email of an individual and/or organization that you would recommended for membership in the Phoenix Equity Group.

APPEAL's National Cancer and Tobacco Disparity Network

May we add you to APPEAL's national network of advocates and supporters working toward reducing and eliminating cancer and tobacco disparities?

Yes

No