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OWN it Membership Form
OWN it Membership Form
Name of the Organization or Individual *
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Name of Primary Contact *
Your answer
Address (Mailing)
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Address (Physical):
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Daytime Phone (Office):
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Cell Phone
Your answer
Email:
Your answer
Agency Website:
Your answer
Name of agency representive who will vote in the absence of the primary contact
Your answer
Primary Contact: Each OWN it member must be active in at least one Action Team or Committee. Please check your preferences below: Your selected preference(s) will be taken into consideration when assigning you to an action team or committee. *
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If additional individuals from your agency will be a part of OWN it, please list their name, phone number and email below. If your organization will not have any additional representation, please leave blank.
Name & Phone Number & Email for additional agency representation:
Your answer
Please check the preferences below: The selected preference(s) will be taken into consideration when assigning this representative to an action team or committee.
Name & Phone Number & Email for additional agency representation:
Your answer
Please check the preferences below: The selected preference(s) will be taken into consideration when assigning this representative to an action team or committee.
Name & Phone Number & Email for additional agency representation:
Your answer
Please check the preferences below: The selected preference(s) will be taken into consideration when assigning this representative to an action team or committee.
Name & Phone Number & Email for additional agency representation:
Your answer
Please check the preferences below: The selected preference(s) will be taken into consideration when assigning this representative to an action team or committee.
Name & Phone Number & Email for additional agency representation:
Your answer
Please check the preferences below: The selected preference(s) will be taken into consideration when assigning this representative to an action team or committee.
Once you submit this form, a member of the OWNit Membership team will contact you about the next steps to becoming an official OWNit partner.
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