To become a member of BANPAC, please submit your contact information using the form below. There is no fee or obligation associated with membership, simply the desire to improve the health of your community! You will automatically be added to the Member Contact List and/or Member Agencies Search page according to the information you provide.

We look forward to your membership!

Please note: By submitting your request via this online form, you authorize your information to be placed on www.banpac.org Member Contact and Search Agencies Web Pages.
For any questions contact Susan Karlins at 408.792.5121.

EXISTING WEBSITE ROSTER MEMBERS
WHO HAVE NOT SUBMITTED YOUR KEYWORDS AND PROGRAM DESCRIPTION...DO NOT COMPLETE THIS ENTIRE FORM.  Complete only those entries in red.

Please complete the following form to submit your information to become an BANPAC Member:

  
   
 
Name w/ Credentials
Title

Organization
Address
City
Zip
County
E-mail
Tel
Fax
URL

Please describe why are you interested in BANPAC?

In which of the following committees are you interested in participating:

Do you want to be an ACTIVE MEMBER (attend meetings AND trainings WITH voting privileges) or INACTIVE MEMBER (e-mail list only)?  Select one please:
Active Member
Inactive Member

Please select only ten (10) words that describe your organization from the list below:
Existing Website Roster Members, complete this area.

Adults
Advocacy
Adolescents
African American
Asian
Asian American
Boys
Breastfeeding
Coalition
Community Food Security
Cooking Healthy
Cooperative Extension
County Services
Dairy
Education
Educational Media
Elementary Schools
Exercise
Families		 Filipino/Philipino
Fitness
Food Banks
Food Demos
Food Safety
Food Stamps
Fruits and Vegetables
Funding
Girls
Health Promotion
High Schools
Hunger
Infants
Latino
Low Income
Meal Planning
Medical
Middle School
Native American		 Nutrition
Nutrition Education
Obesity
Overweight
Pacific Islander
Physical Activity
Policy
Prenatal
Public Health
Referrals
Seniors
Social Marketing
Spanish
Supermarkets
Volunteerism
Website
Workplace
Youth

Please provide a brief program description of your organization.
Existing Website Roster Members, complete this area.

Are you already an existing member who has given permission for your information to be placed on this Website?  Existing Website Roster Members, complete this area, then Submit.  Thank you!
 Yes  No
 

To update your information or for Website inquiries, contact Webmaster.