AFFILIATE STAFF CONTACT FORM

In an effort to communicate and collaborate more effectively with the MHA Affiliate Network, MHA is collecting contact information on key affiliate staff dealing with communications, development, education and policy. It’s our intention to use this contact information to share resources from National to support and assist in affiliate efforts, and to get input and feedback on existing and future resources and initiatives.

Please take a moment to complete this brief survey or have the appropriate staff person complete the survey to ensure we are communicating with the appropriate staff within your organization.

Question Title

* 1. Contact Information

Name:

Affiliate Name:

Email Address:

Phone Number:

Question Title

* 2. What department or area do you work in?

Communications

Development

Education

Policy

Question Title

* 1. Contact Information

Question Title

* 2. What department or area do you work in?

Question Title

* 3. What are your key duties and responsibilities?