Rock Center Coalition

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Membership Application

Email *

First Name *

Last Name *

Address *

Telephone Number *

Birth Date *

YYYY

Sex *

Referring Members Name *

Select your membership level.

Active Members attend meetings regularly and are involved in the day-to-day work of the Coalition

Supporting Members may not be able to attend all meetings regularly, but are familiar with the work of the Coalition and support the efforts.

Advisory Members are not necessarily involved in the day-to-day work of the Coalition, but they recognize the importance of the work in the community and are willing to be contacted occasionally to advise on specific issues or help with specific tasks.

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Payment *

$25 Annually - Receive an Emailed Invoice

Student (Student Memberships are Free)

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