First Name

Last Name

Email Address

Home Address Line 1

Home Address Line 2

City

State

Zip Code

Phone Number

Please list any other communities where you would like to get involved (i.e. where you work, go to school, etc)

Message

Are you currently on CHAPA's general email database? Are you currently on CHAPA's general email database? Yes No Not Sure

If no or unsure, would you like to be added to CHAPA's general email database? If no or unsure, would you like to be added to CHAPA's general email database? Yes No

Are you affiliated with CHAPA in any other way? (On a CHAPA Committee, attend Regional Meetings, work for a housing organizational member, etc.)

Please share any local levels of engagement you are involved in. (Housing Trust, Advocacy Group, Community Preservation Committee, Planning Board, regularly speak at community meetings on housing, work for local housing organization, etc.)

How did you find this form? How did you find this form? CHAPA Webpage Email from CHAPA Heard about it at a CHAPA Event Referred by a friend or colleague Other: