A Volunteer Coalition Dedicated to Improving the Health and Well-Being of Those Who Live

A volunteer coalition dedicated to improving the health and well-being of those who live and work
in the communities of Braintree, Canton, Cohasset, Hingham, Hull, Milton, Norwell, Norwood,
Quincy, Randolph, Scituate, Sharon, and Weymouth. Membership is open to all.

Membership Form

The Massachusetts Department of Public Health (DPH) established Community Health Network Areas (CHNAs) in 1992. CHNAs are coalitions of public, nonprofit and private sectors working together to build healthier communities through community-based prevention planning and health promotion. Today, CHNAs involve each of the state’s 351 towns and cities through 27 networks. Participation in the Blue Hills Community Health Alliance (CHNA 20) is open to anyone. Membership benefits include opportunities to:

•  Network and share ideas with people with similar interests in building healthier communities

•  Gain knowledge about a range of health-related issues and topics

•  Participate in designing and implementing health-improvement projects

•  Advise Massachusetts DPH on programs and the funding process

•  Advocate for health issues that are important to your organization and community

Name: ______

Title: ______

Organization: ______

City: ______State:______Zip: ______

Phone:______Fax:______

Preferred email address: ______

How did you first hear about CHNA 20? ______

Please let us know how you’d like to get involved (check all that apply):

£  Guide the successful implementation of CHNA 20’s annual plan (Steering Committee)

£  Provide fiscal oversight and budgetary guidance (Finance Committee)

£  Encourage others to become involved (Membership Committee)

£  Promote CHNA 20’s good work (Promotion and Website Committee)

£  Assist with funding decisions (Grants Management)

£  Support the assessment of community health (Assessment & Evaluation Guidance Group)

£  Help to plan events, programs, and educational activities (Programs Committee)

£  Other: ______

______

Please complete and return this form to Blue Hills Community Health Alliance, Kym Williams, Community Health Specialist, C/O Baystate Community Services, 1120 Hancock Street, Quincy, MA 02169

Thank you for your interest!