Tri-County Human Trafficking Task Force Membership and Update Form
For new members and/or to update agency information please complete the following questions:
Individual Applicant Name
Date of Birth
Main Telephone Number/Point of Contact
Organization/Agency Name (if applicable)
Agency Owner/CEO/President/Director/etc (if applicable)
Description of Organization/Services Provided (if applicable)
Do you mind if your contact information is shared with other members?
Would you like to join a committee? (not mandatory; check all that apply)
Legislative Policy/Legal Committee
Health Care/Public Health Committee
Labor Trafficking Committee
Educational Systems Committee
Law Enforcement Committee
Faith Based Committee
Youth Advocacy Team
Survivor Leader Committee
Victim Services/Advocates Committee
Would you like to receive email updates about task force news and events?
Thank you for your submission and participation. (All collected information is used for processing membership requests and updating purposes only)
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