Membership Form
To become a member of the Pacific County Teen Advocacy Coalition, please complete and submit this membership form. Membership forms are reviewed at our coalition meetings on the second Monday of every month.
First Name *
Last Name *
I am joining as an: *
Name of Organization (if applicable)
Mailing Address *
City *
State *
Zip *
Phone
Email *
Please select which sector of the community you best represent. *
Please share the reason you would like to be part of the coalition.
Please share any special skills or area of expertise you or your organization could bring to the coalition.
I would like to be involved in the following committee(s) (select all that apply):
I agree to receive emails about coalition meetings, events, and other information. *
Signature *
By typing my name below, I am agreeing to support the mission of the coalition by playing an active role in the prevention of substance misuse in North Pacific County, networking with local partners to share information, using opportunities to participate in coalition activities, and providing input toward coalition efforts.
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