National Baptist Convention, USA, Inc.

H.O.P.E. HHS Partnership

PO Box 994
Hernando, MS 38632

Home
About
Op Ed Page
Trinity Wellness
A Better Way
Fit for Service
All of Us
- Data Form
COVID19
Photos
Volunteer
Webinar Survey
Training Survey
Initiatives
Health Fair
Collaboration
Training
Monthly Health Observances
Wear Red Sunday
Medical Home Options
Contact

Volunteer

H.O.P.E. Volunteer Commitment Form

Click to enter an introduction to your customer information form here.

Tip: Tell visitors why you're requesting their contact information, and let them know that you won't sell or share their contact information with other businesses.

*First Name:

*Last Name:

*Email:

*Phone:

*Contact Preference:

Address Line 1:

Address Line 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Join E-mailing List?

Please add me to your e-mailing list.

*Church Name:

Church Address

Church Web Site:

Church City:

Church State/Province:

Church ZIP/Postal Code:

*State Convention

*Area of Expertise:

Health Ministry Advocate Health Professional: MD, RN, etc. Dietician Community Health Worker Other (Include in the comments box below.)

*Area of Interest:

Alzheimer's Disease Association American Cancer Society Prostate Cancer Awareness Sickle Cell Anemia Disease Association Other (Include it in the comments box below.) American Diabetes Association American Heart Association American Kidney Fund American Stroke Association Breast Health Awareness HIV/AIDS Awareness Lupus/Multiple Sclerosis Pancreatic Cancer Awareness Network

*Does your church have an existing health ministry?

Yes No

*Are you interested in taking or hosting a H.O.P.E. Health Ambassador Training?

Yes (If yes, include possible dates in the comments box.) No

How did you hear about NBCUSA H.O.P.E.?

Comments:

Submit Your Responses:

Thanks and God bless you for your participation!

Web Hosting by Yahoo Small Business

PO Box 994
Hernando, MS 38632