Health GAP and SGAC Grassroots Leader Form
Thank you for your interest in taking leadership in your own community to work for equal treatment access for all people! Health GAP community leaders receive support, training, and adequate resources to effectively advocate for universal HIV treatment around the world. We are happy you've decided to advocate with us!

Please fill out the form below, and a Health GAP staffer will be in contact with you as soon as possible.

First Name *
Your answer
Last name *
Your answer
Email *
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Phone # *
Your answer
Address *
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City/State *
Your answer
Zip code *
Your answer
Your Congressional District (if you know it) *
Your answer
Why are you interested in campaigning for universal access to HIV treatment? *
Your answer
Are you involved in other advocacy/activist organizations? If so, please tell us which organizations and what sort of experience you've had with them. *
Your answer
What are the best days/times for conference calls? *
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Anything else you'd like us to know?
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