Healthy Mothers, Healthy Babies | Coalition of Georgia

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.

All donations and membership fees are tax deductible. Click here for a copy of our IRS determination letter.

* First Name
* Last Name
Company Name
* Address Line 1
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* Town
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* E-Mail Address
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Mail correspondence:	Home Address
	Work Address
I would like to participate in the following committee(s):	Public AffairsResponsible to the Board for HMHB's legislative and public policy agenda.
	FundraisingDirects fundraising efforts to support the organization.
	CommunicationResponsible for increasing membership and Board recruitment.
* Payment Option	Credit Card Payment Check Mailed
* Name on Membership Payment
Is this membership a gift?
* Membership Option	Individual Membership - $35.00 Organizational Membership (Includes 3 staff) - $100.00
Please type in the letters you see:	[Change letter code]