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Organizational Membership Application

Please choose the appropriate tier and 330h grant amount or homeless services budget below. The dues amount associated with each level is listed at the end.

Organization Information:


Organization Official Representative Information:

The representative serves on the Governing Membership of the National Health Care for the Homeless Council and is also the contact person for all Council business.

Alternate Representative Information:

If your Organizational Representative is unreachable, who may we contact?

How did you hear about the Council?

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