Name *

First Name

Last Name

Phone

(###)

###

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Many skills and assets play a role it IMPACT's work. Please select any of these categories that interest you. * *

Funding

Events + Community

Marketing + Awareness

Research + Development

Other

What do you want your role to look like (this can change at any time)? * *

Interest - (ie.., newsletter, opportunities to participate in events)

Supportive - (ie.., attending community events, answering surveys, sharing with others)

Involved - (ie., attending specific discussions, committees, and/or workshops)

Core - interested in being actively involved in the functioning of IMPACT

N/A