Nutrition and Physical Activity
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Alabama Wellness Alliance Membership Application

"Partnering to improve nutrition and physical activity in places where Alabamians live, learn, work, play, and worship."

Purpose Statement:
"The Alabama Wellness Alliance (AWA) works through collaboration, programs, policy, and environmental changes to support and promote healthy lifestyles."

  Welcome to the Alabama Wellness Alliance.
We are delighted that you are interested in joining our efforts. The strength of the Alliance comes from our members and the experience they share. To help maintain a membership data base and learn more about your interests, please complete the following information.


* Full Name:

* Email Address:
(Our correspondence is via email)

* Daytime Telephone Number:
(Include area code)

* Organization:

* Address:

* Job Title:


* Please use the map to select the region where you are located:

If unsure, enter your county:


* What region or area does your organization cover? Please describe:

Please list any certifications that you currently hold:

Please check your area(s) of interest:

Business and Industry  
Fitness and Sports  
Non-Profit, Volunteer, and Faith Based Organizations  
Public Health  
Public Lands, Parks, and Recreation  
Transportation, Community Planning, and Access  
Data, Surveillance, and Research  

Please describe your experience and/or training in the(se) area(s):

List any talents you are willing to share, such as: writing, speaking, organizational skills, computer skills, meeting sponsorship, etc.

How active in the Wellness Alliance do you plan to be?
Choose all that apply

Staying up-to-date on activities via email communications  
Sharing news and events with my network  
Attending online meetings  
Attending meetings in my general area (when COVID is no longer a concern)  
Attending meetings in different parts of the state (when COVID is no longer a concern)  
Traveling to other states to represent the AWA  
Participating in "work groups" that meet outside of the AWA general meetings  
Leading/organizing "work groups" that meet outside of the AWA general meetings  
Interested in serving on the Board  
Interested in serving as the Chair  

Are you interested in being a Wellness Alliance Advocate to represent the group at speaking engagements, meetings, expos, and events, etc.?

How does the work you currently do intersect with the work of the Wellness Alliance?
Please describe

Is your organization interested in providing funding for AWA initiatives/events?
Please describe

Thank you for your interest in the Alabama Wellness Alliance!
We will contact you soon regarding your application.