Healthy Infant and Child Alliance

Healthy Infant

Child Alliance

3365 W. Brewster Street * Appleton, WI 54914-1602 * 920-832-5121

Want to join? It's simple!

Just fill out the form below, print it, and mail it with your check to:

Healthy Infant and Child Alliance

c/o UW-Extension
3365 W. Brewster Street
Appleton, WI 4914-1602

or contact Karen Dickrell at UW-Extension
920-832-5121
email: Karen.dickrell@ces.uwex.edu

Membership runs from January 1 through December 31 annually.

New $20 Individual Membership Renewal $20 Individual Membershp

Organization/Company:

Contact Person:

Address:

City: ZipCode:

Phone: Fax:

What is your role in serving infants, children and families in the Fox Cities? (Please check all that apply)

Parent Child Care Provider Health Professional Social Services

Educator Business Other (please describe below):

Your HICA membership allows you to:

Become active in improving children's lives in the Fox Communities
Take part in organizing opportunities to make a difference for children and families
Join with others who care about children to improve children's health, education, care and related services
Receive meeting minutes, agendas and information on upcoming events

We propose to broaden the focus on all young children
to be healthy, happy and successful achievers

updated 16-May-2006