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Please fill out the Pinellas Continuum of Care (CoC) Lived Experience Membership application completely .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 HERE. If you have any questions, please contact Victoria Kelly with the Homeless Leadership Alliance of Pinellas at VKelly@HLAPinellas.org.
New or Renewing Membership: *  
Member's Information

Name *
Title
First Name
Last Name
Suffix
Does the applicant live and/or work in Pinellas? *  
How recent is your experience with homelessness? *  
Please select your age range: *  
Cell Phone Number:
Email Address: *  
Address: *  
Address Line 1
Address Line 2
City
State
Zip
Organization (if applicable):
Job Title (if applicable):
Are you interested in joining Councils/Committees?  
Additional Information

CoC Organizational Affiliations:  
Do you have any questions?  
What services are most needed in our community?  
How would you like to get involved in the CoC?
Would you like to volunteer within the CoC?  
CoC Conflict of Interest Policy

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

Please enter the number 1 here: *  

Please fill out the Pinellas Continuum of Care membership application completely. If you have any questions, please contact Victoria Kelly with the Homeless Leadership Alliance of Pinellas at VKelly@HLAPinellas.org.

Lived Experience Members do not owe annual membership dues.