Become a Member

Consortium membership is free and open to all individuals who share the vision, mission and goals of the Consortium. If you are interested in becoming a member of the Consortium, please simply fill out the form below.

I am a *

Student? *
Yes No

First Name *

Last Name *

Company/Org Name *

Company/Org Website *

Position/Title *

Credential

Address 1 *

Address 2

City *

State *

Zip Code *

Email Address *

Phone Number 1 *

Phone Number 2

Fax Number

Type of Organization *

COMMITTEES

The Consortium is comprised of the eight (8) committees listed below. Each committee works collaboratively with public and private partners to plan various initiatives targeted to specific groups in an effort to address leading health issues affecting Miami-Dade residents. Please select the committee(s) you are interested in becoming a member of and the type of membership you would like.

Committee 1 *

Member Type 1 *
Active Member Member At Large

Committee 2

Member Type 2
Active Member Member At Large

Committee 3

Member Type 3
Active Member Member At Large

Agreement

By signing this membership agreement, * I agree to work collaboratively with the above-selected committee(s) of the Consortium to organize effective county-wide initiatives to promote healthy lifestyles and enhance the quality of life of Miami-Dade County residents. I also consent to have my contact information be shared as part of the Consortium directory. *

IMPORTANT NOTE: Once your membership has been processed, you will receive an email notification from ConsortiumForaHealthierMiamiDade@flhealth.gov. You may need to check spam filters/folders, or request this address be added to your organizations spam filters.

Enter Confirmation Number