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CoC Membership Renewal
Lived Experience Members

Individuals who are currently experiencing homelessness or who have experienced homelessness within the past 7 years may apply for the Lived Experience CoC membership. Others may apply as Concerned Citizens at www.pinellashomeless.org/pinellascoc.
Name: *
Title
First Name
Last Name
Suffix
Cell Phone Number: *
Email Address: *
Does the applicant still live or work in Pinellas? *  
How recent is your experience with homelessness? *  
Address *
Address Line 1
Address Line 2
City
State
Zip
Are you interested in joining Councils/Committees?  
CoC Conflict of Interest Policy

Do you agree to the Conflict of Interest Policy? *  
Voting Policy *
Disclosure *
Conflict of Interest, Additional Information:  
Inquiry *
Other

Please enter the number 1 here: *  

Membership dues for Lived Experience Members are $0.00 annually.