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Campaign Sign-up

MATERIALS ARE ONLY AVAILABLE TO ORGANIZATIONS IN PARK HEIGHTS, MADISON EAST END/PATTERSON PARK AND SOUTHWEST BALTIMORE.

Yes, my organization is located in one of the targeted communities and I want to become a community partner with the Change The Game Campaign. Please send me materials so I can begin our work in the community.

Please verify your contact information below and submit this form via the Internet; or print and fax it to (410) 752-2124.

Fields marked with * are required
Organization*:
Job Title*:
Title*:
First Name*: Last Name*:
Address line 1*:
Address line 2:
Suite/Apt City*:
State*: Zip Code*:
Phone: Fax:
E-mail (required for access to member only sections)*:
Enter a password (for access to member only sections)*:
Organization Web Site:


What types of services do you provide?
After School Program Mentoring
Alcohol Abuse Nutrition
Child Abuse Parenting
Computer
Training 		Peer Education
Criminal Justice Performing Arts
Domestic Abuse Physical Disabilities
Drug Abuse Pregnancy
Employment Assistance Prevention
Gun Violence Sexual Assault
Health Sexually Transmitted Disease
HIV/AIDS Related Smoking Prevention
Homeless Sports and Recreation
Housing Support Group
Internet Technical Assistance
Learning Disabilities Treatment
Mental Health Violence

What MEE services and campaign activities would be of interest to you?
HIV/AIDS Campaigns Sexual Health Issues
Focus Groups Wordships / Trainings
Violence Prevention Smoking Prevention
Drug / Substance Abuse Entertainment Campaigns

Who do you serve?
Youth / Teens Adults
Homosexuals Seniors
African Americans Transgenders
Latinos Causasians
MSMs Native Americans
Asians Bisexuals

Brief description of what your organization does:

Number of Brochures Requested:
 5    10  

Number of Posters Requested:
 1    2    5    10

Number of Postcards Requested:
 5    10   25    50  

Number of Videos Requested:
 5    10  



Please allow up to 72 hours for your Community Membership to be processed and activated. You will receive an email notification upon the approval of your membership request and a membership packet will be mailed to you.

   
For more information call 215-829-4920 or 1-877-MEE-PROD

For more information on the MEE Community Network, send an e-mail to: communitynetwork@meeproductions.com

MEE Community Network