Header Image
Pinellas CoC New Member Application (Individual or Organization)
Pinellas CoC New Membership (No Dues Required)

To renew an existing membership:www.pinellascoc.org/join
Name *
Title
First Name
Last Name
Phone *
Email *
Mailing Address *
Address Line 1
City
State
Zip
Organization (if applicable)
Job Title (if applicable)
Website (if applicable)
Pinellas County Affiliation *

Pinellas CoC members must live, work, or attend school in Pinellas County, or represent organizations that serve Pinellas County. Applicants that do not meet this criteria are ineligible for membership.
Sliding Fee Scale of 100% available for:
Organizations with an annual operating budget under $250,000 or 2 or fewer full-time employees are eligible for 100% off membership dues. Organizations requesting a sliding fee scale are asked to submit a copy of their annual budget and/or organizational chart to confirm eligibility.
Documentation Upload *

Upload documentation HERE.
Have you experienced homelessness? *
Membership Type (No Dues Required) *

More information can be found on membership benefits and levels here: www.pinellascoc.org/join
Conflict of Interest
Agreement *
Questions and Comments

Any questions, comments, or concerns can be emailed to info@hlapinellas.org
To verify you are human, please enter the number 1 *

Homeless Leadership Alliance of Pinellas
647 1st Ave North, St. Petersburg, FL 33701
www.pinellascoc.org
Info@HLAPinellas.org