Volunteer

Name

First

Last

Layout

Email

Confirm Email

Mobile Phone

If you have a mobile phone, enter it here.

Landline

If you have a landline, enter it here.

Website

If you have a website, please enter it here.

X (Formerly Twitter) Handle

If you use X.com, provide your username here

Facebook Page

If you use Facebook, provide your profile page here

Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred method of contact

Phone call
Email
Text
No preference

Choose Your CHBMP username

Enter your desired username for use on the site.
Your username MUST BE LOWERCASE: no capital letters allowed in usernames.
Your username must be between 4 and 30 characters long.
Your username can only contain letters, numbers, underscores, hyphens, periods, and the @ symbol.
Your username cannot contain spaces.

About you

Please provide a brief bio. Tell us a bit about yourself. Your bio will be made available on your CHBMP profile and may be visible to other volunteers.

Is Your Employer A Government Agency, Federal Contractor, or Military?

Yes
No

What are your strengths?

Please check all that are applicable to your experience, skillsets, and strengths.

Have you already been engaging with CHBMP?

Yes, I have come to the support group
Yes, I've been to CHBMPorg Spaces
Yes, I engage with and share CHBMP content
Yes, I have been engaged in other ways
No

Are you interested in serving as a state chair or co-chair?

Yes, I would be interested in being a state chair.
Yes, I would be interested in being a state co-chair.
Maybe, I would like to learn more.
Not at this time.

Tell us why you are joining CHBMP and what you hope we accomplish.

Please write a few words about why you are in this fight and what success for this mission would look like to you.

How did you find out about CHBMP?