ARCH - The Alliance for Rural Community Health

ARCH Grassroots Action Form

First Name
Last Name
E-mail
What is your health center’s name?
Zip Code
Do you serve as a Board Member at a health center?		yes no
Do you work at a health center?		yes no
Do you wish to receive Pulse, the e-mail newsletter published by ARCH?		yes no
Do you wish to receive state and local updates from ARCH?		yes no
Do you wish to receive updates on federal issues from the National Association of Community Health Clinics (NACHC)?		yes no