Language English Organization name * Contact Information First Name * Last Name * Email * Telephone * Address * City/Town * Postal Code If your organization is involved in a project or collaborative that incorporates the healthy communities model, please provide the name and a brief description below. The Healthy Communities model involves different organizations from different sectors collaborating on efforts to improve the social, economic, and environmental well-being of their community. Do you agree to have your organization's name published on our website and in our annual report? Yes, you may publish my name No, I prefer to remain anonymous Payment OptionsAfter clicking "Submit" you will be prompted for payment information. You have three options: online (CanadaHelps), cheque, or electronic transfer. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.