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Get Involved

Membership Application

Join HMHB and you won't be the only one who benefits.

Becoming a member of Healthy Mothers, Healthy Babies Coalition of Georgia means you're supporting one of the most progressive and effective coalition groups. Healthy Mothers, Healthy Babies Coalition of Georgia is a dedicated alliance focused on improving access to healthcare for Georgia's families through innovative programs.

Contact Information:

First Name*

Last Name*

Address 1*

Address 2

City*

State*

Zip Code*

Contact Phone*

Email*

Company Information:

Organization

Title / Position

Address 1

Address 2

City

State

Zip Code

Work Phone

Fax

I prefer correspondence mailed to:
Home Address

Work Address

Committees:
Members are welcome to serve on standing committees.

I would like to participate in the following:
Public Affairs
Responsible to the Board for HMHB's legislative and public policy agenda.
Fundraising
Directs fundraising efforts to support the organization.
Communication
Responsible for increasing membership and Board recruitment.

Payment Options:*

Credit Card - $35.00
Name on Credit Card Payment

Check Mailed - $35.00
Name on Check Payment

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