CBHC Membership Application Are you interested in becoming a member? A CBHC Member is a person or organization that attends, signs-in and participates at CBHC Events. If you are interested in becoming a member of CBHC, please complete the application form below. First Name (required) Last Name (required) Address (required) City (required) State (required) Zip Code (required) Email (required) Phone (required) Age (required) < 17 Years Old18 - 24 Years Old25 - 39 Years Old40 - 49 Years Old50 - 64 Years Old> 65 Years Old Sex (required) MaleFemale Race Ethnicity (hold Ctrl to select all that apply) African American / BlackAsian / Pacific IslanderCaucasianLatino / HispanicNative American Skills (hold Ctrl to select all that apply) Educator/TrainerAdministrativeFacilitationResearchPolicy and LegislationCommunity OutreachHealth EducationEvaluationEvent PlanningGrants/nonprofit developmentWeb DesignYouthSeniorsBusiness/Accounting What would you like to achieve as a participant of the CBHC? With respect to CBHC’s mission, what strengths do you bring to the collaborative? Current Job Responsibilities Volunteerism: Boards, Community etc.