CTFWV Membership Application
Thank you for your interest in becoming a member of Coalition For A Tobacco-Free West Virginia. The mission of CTFWV is to improve the health of West Virginia residents by decreasing the morbidity and mortality associated with tobacco use (including vaping) and exposure through education, public policy, and advocacy using culturally competent, and evidence-informed approaches with the intent to eliminate, tobacco use in West Virginia.
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Date *
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Conflict of Interest: I affirm that, as of today, I/we have not accepted tobacco industry funds in the past year. *
As a member, I agree to:
• Promote and support CTFWV’s mission.
• Contribute resources (e.g. information, volunteer time, financial support).
• Participate in CTFWV conference calls, meetings, and activities.
• Represent CTFWV in a respectful and professional manner.
• Provide information on membership, communications, and funding opportunities
• Provide information on state and local policy issues and activity.
• Eliminate and disclose any conflicts of interest.
As a member, you can expect to be treated with respect and equality at all times.
Benefits include:
• Eligibility to serve on the steering, executive, membership, public policy, communications, or ad hoc committees.
• Technical assistance.
• Training opportunities led by coalition members and consultants.
• Timely notification about tobacco control potential legislation, news, events via Facebook and email
• Opportunity to provide input and feedback.
• Information about best and promising practices.
• Networking opportunities with professionals at the state and national levels.
Name: *
Email: *
Organization and Title (if applicable):
Local health or tobacco control coalition(s) I belong to:
(To receive specific action alerts on legislative issues, the following information is helpful)
Home County
County/ies where you work:
Cell Phone
May we send you text messages?
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State legislators you know or have contacted:
PRIVACY POLICY: We will not share or sell your personal or work data with any other groups or organizations without your permission.
TAKE ACTION!  I'm willing to: *
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Areas of interest:
There are no membership dues at this time, though donations are appreciated and can be discussed with the CTFWV Chair. CTFWV will utilize donations to support the mission of the coalition. Membership extends for 2 years from date the application is received by CTFWV.
Creating a healthier West Virginia by eliminating the burden of tobacco.
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