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Healthy Contra Costa Get Involved Form - Health & Racial Equity Happens in our County and It Starts With You!
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Name
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Email or Phone Number or both
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Check all that you are interested in joining:
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HEALTH- Access to Quality Healthcare Action Team's monthly meeting (
https://healthyrichmond.net/action-teams/
)
SCHOOLS- Schools & Neighborhood Action Team's monthly meeting (
https://healthyrichmond.net/action-teams/
)
ECONOMIC- Economic Justice Action Team's monthly meeting (
https://healthyrichmond.net/action-teams/
)
YOUTH - Are you below the age of 21 and want to learn more about youth advocacy, opportunities, programs, etc.? (
https://healthyrichmond.net/youth-power/
)
CALLS TO ACTION - get emails about what's happening in Richmond and how to take action (
https://healthyrichmond.net/events/
)
STEERING COMMITTEE - apply to become a SC member, who helps to uphold, preserve, and oversee the principles and goals of the collective. Availability of seats are limited. (
https://healthyrichmond.net/structure-staff/
)
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How can we support YOU and your advocacy, action, and needs as it relates to Richmond?
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Other details you would like us to know about you?
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Stay In Touch
Like us on Facebook (
https://tinyurl.com/y9uubd8r
) and Twitter (
https://tinyurl.com/y756phy3
)
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