Thank you for your interest and participation in Civitas Networks for Health. We appreciate you taking the time to thoroughly complete the information below to help us best understand your organization's structure, priorities, mission, and goals for participating in the organization.

Whether you are looking to join Civitas as a new member or are a longstanding member and are renewing your membership, we request that you answer all questions as thoroughly as possible. We will also request annual updates and all members must accept the terms and conditions and code of conduct, and contribute annual dues established by the Civitas Board of Directors.

The form uses logic and may prompt additional questions based on your selected response. If you have questions, please email contact@civitasforhealth.org.