Hep Free AZ Subcommittee Sign-Up Sheet
The purpose of this survey is to gauge member interest and availability for participation on the following subcommittees: Membership, Data, Marketing/Communications, Advocacy. The survey will remain open on a rolling bases until all subcommittee membership roles are filled.

Please note that subcommittee membership will require a time commitment of 20 hours per quarter and will be limited to six (6) members AND one (1) Action Leader. Action Leaders will regularly report to the Executive Committee and chair subcommittee meetings. Due to the limited capacity for membership, we request that you rank your subcommittee preference (highest priority to least). The Executive Committee will review survey responses in conjunction with each respective members' initial Group application when determining subcommittee placement.

Sign in to Google to save your progress. Learn more
Name *
Affiliated Organization and Title
Email *
Do you certify that you are able to fulfill a time commitment of 20 hours per quarter? *
Hep Free AZ Subcommittee Descriptions
Descriptions of the roles and responsibilities for each sub-committee are outlined below:

Membership- This Group will receive and manage applications for new members, develop outreach strategies and provide guidance for the Hep Free AZ Leadership Program.

Data- This Group will work to identify community data needs, new data sources and the collection, analysis and dissemination of hep C related information.

Outreach/Communications- This Group will focus on marketing Hep Free AZ and its affiliated programs within the community, manage the monthly Newsletter and plan Hepatitis Awareness Month activities.

Advocacy- This Group will work with community members, local and state government representatives, and other parties to advance hep C-related initiatives.
Strongest Preference? *
How can you contribute to this Subcommittee?
Second Choice? *
How can you contribute to this Subcommittee?
Third Choice? *
How can you contribute to this Subcommittee?
Any questions, comments, or considerations?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of State of Arizona. Report Abuse
Google Forms