The East Harlem Information Outreach Project A service provided by the New York Academy of Medicine Library for community-based organizations in East Harlem.

The East Harlem Information Outreach Project

If your organization is a not-for-profit community-based organization in East Harlem (zip codes 10029 and 10035), then you are elible for membership in the East Harlem Information Outreach Project.  Print out the form below, complete it, then fax it to (212) 423-0266 OR mail it to the HIV/AIDS Information Outreach Project, The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5293.  Questions?  Contact us.

Community-Based Organization (CBO) Registration Form Organization Name:_____________________________________________ Address: _____________________________________________________ _____________________________________________________________ _____________________________________________________________ Phone: ________________________ Fax: __________________________ Health/social organizational focus: _________________________________ Target Population(s):   ______________________________________________ Contact Person(s): (Please provide the names, phone numbers and e-mail addresses of all persons in the organization that may use this service. Attach additional pages if necessary.) Name: _____________________ Phone:______________ E-mail:________________ Name: _____________________ Phone:______________ E-mail:________________ Name: _____________________ Phone:______________ E-mail:________________ Does your organization currently have a Web site?   YES___ NO___ If YES, please provide the address below. CBO’s Web Address: _____________________________________________ If NO, are you interested in having the Outreach design and host a site for you?   YES___ NO___ Please describe the services that your CBO provides to the East Harlem community. Attach additional pages if necessary. _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ If you have questions or need more information please contact the Outreach Project coordinator at (212) 822-7323.

The East Harlem Information Outreach Project The New York Academy of Medicine Library | 1216 Fifth Avenue | New York, NY  10029 Tel: (212) 822-7323 | Fax: (212) 423-0266 | eharleminfo@mail.nyam.org © 2004 The New York Academy of Medicine