Hawaii Immunization Coalition, Protecting Hawaii's Families

Join the Hawaii Immunization Coalition

We would love to have you join our teams!
To join the Hawaii Immunization Coalition, complete
the fillable membership form below and click Submit.
A representative of the coalition will contact you.



Membership Form
Name :-
Title :-
Organization :-
Email address :-
Mailing address :-
City/State/Zip:-
Phone :-
Fax :-
Count me in as an :- Individual Member Company/Organization member Both
Current areas of interest and/or responsibility in immunization (ie. health education, data collection and reporting, clinical services, special population groups):
Are you a vaccine provider?:- Yes No
How did you hear about HIC?
In order for HIC to be effective, we need your active participation. Working team members make everything happen. Please select one or more of the teams below in which you will actively participate.
Infant Team : This team focuses on immunization issues for children 0-12 years
Adolescent/Adult Team : This team focuses on immunization issues for young adults ages 13-21 and adults 21 years of age and older.


Volunteers are needed in all capacities. Please indicate how you will be willing to help:
Staff a shift at a health fair booth
Provide In-Kind contributions
Assist with HIC fundraising (printing, meeting space, etc.)
Assist with legislative issues
Help recruit members
Help with Research
Help recruit volunteers
Assist with Public Relations
Serve as HIC Spokesperson
Assist with Marketing
Assist with HIC website content