ASAP Membership Form
ASAP Membership is voluntary and free. The following information will be kept confidential and only used by ASAP Coordinator, Chairperson, and committee chairs to maximize our prevention efforts in Pasco County.
First name:
Your answer
Last name:
Your answer
Email:
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I represent the following groups: (Please select up to 2 options)
Required
Business/Organization/Affiliation:
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Street address:
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City:
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State:
Zipcode:
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Phone number:
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Please select all of the committees in which you would like to participate (Note: you can be a committee member even if you cannot attend the committee meetings).
Please describe why you are interested in working with ASAP or one of the subcommittees (ex: it is relevant to my work, networking, to make a difference):
Your answer
Help us find a fit for your talents and interests: (Check any interest or skill you’d like to apply to ASAP)
other:
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Please list any groups, associations, or organizations you are part of and which may be interested in learning more about drug and alcohol prevention (Example: HOA, sports team, local non profit, volunteer program, church group, Chamber of Commerce, etc.).
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Please write how ASAP can serve you and your work/interests.
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