MoMENtum -- A Social Group for Gay and Bisexual Men in Eastern Iowa

Please fill out the following form to become involved with Momentum

First Name*		Last Name
Age		Email
Home Phone		Mobile Phone
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Please check those areas of MoMENtum where you want to become involved:

Outreach/ safer sex promotion

Clerical assistance

Marketing or publicity

Help staff drop-in hours

Web or materials design

Planning events

Please list any other ways you would like to become involved, talents you would like to share, and/or ideas for new projects:

MoMENtum is a program of Johnson County Public Health.
Funded by the Iowa Department of Public Health.