AC4C Membership Form
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Email *
Date:  *
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/
DD
/
YYYY
Your name:  *
What is the name of your coalition/organization?  *
What county (counties) does your coalition serve?  *
Coalition mailing address
 *
Coalition phone number and email address *
How would you like to be involved in AC4C?  Please check the Workgroup and/or Action Team that you believe best matches the skills/interests you can contribute. (There may be an ad hoc committee for various needs as well.  Goal is to have each member involved in some way.  *
Required
AC4C depends on members' skills, knowledge, and service to build our organization work effectively on our mission.  Please mark the activities in which you have an interest or expertise. 
Check boxes
Creating brochures & publications
Creating & maintaining a website
Participating in media interviews
Writing news releases
Taking coalition info to civic groups or organizations you belong to
Being an officer/executive board member
Working on assessment/planning
Working on sustainability
Leading new member orientations
Planning coalition trainings
Recruiting new members
Creating community surveys and assessment tools
Writing letters/emails to officials
Writing letters to the editor
Developing and implementing policies
Contacting elected officials
Working with youth advocacy group/leaders
Are there any other skills or talents not listed you would like to share with AC4C?
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