Erie County Home Team Homeless and Housing Coalition
Request for Membership Form
Name
Agency
Position Held within Agency
Address
Phone
Email
List others you know of within your agency that are involved with this collaborative.
Provide a brief statement regarding your interest and participation in the coalition.
What attributes do you bring that could be of benefit to this collaborative?
Please disclose any conflicts of interest that you may have that could impede in any decision making roles on this collaborative.
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