Support & Membership Form

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To engage with the Tobacco Free Wichita Coalition, please complete the form below:

Your Name *

Email *

Mailing Address *

Phone Number *

Preferred Method of Contact *

Phone

Organization Name (if applicable) *

The Tobacco Free Wichita Coalition has a need for volunteers in many aspects of its day-to-day operations. Please check each area that interests you. *

Activities/Event Planning - Assist with planning and conducting activities

Advocacy - Sharing alerts/resources, contacting City Council, media, etc

Public Speaking - Present or co-present to various community groups

Support Services - Assist with administrative needs

Recruitment - Networking with community partners, volunteer recruitment

Fundraising - Assist with researching and identifying funding opportunities

Required

Indicate your desired level of membership *

TFW Supporter: In order to join the Coalition mailing list, complete and sign this form.

TFW Member: I understand that attendance and active participation by members of the Tobacco Free Wichita Coalition is what has made this organization successful in the past. By signing this form, I agree to be an active member of the Coalition through meeting attendance, volunteering, and promotion.

Agreement: I do not and will not have any ties with the tobacco industry. I am fully-committed to the goals of the Tobacco Free Wichita Coalition and will not intentionally take any actions that will adversely impact the Coalition's ability to fulfill the mission.

Agree to the statement above by typing your name and today's date. *

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