Membership Application

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Join Us

In applying to become a member of the Coalition for Healthy & Safe Communities, I agree to support the mission of the Coalition and play an active role in the prevention of substance use disorders Sussex and Warren Counties; network with local partners to share information; use opportunities to participate in Coalition activities; and provide input on Coalition efforts. Membership is free.

Full Membership: A general member is one who is interested in the Coalition, wants to receive information and will assist with in-kind services and/or outreach if called upon and available. May also attend monthly meetings when able and/or join a subcommittee

Work Group: A work group committee member is one who attends monthly meetings, assisting with efforts on one of the committees for media/marketing, youth, underage drinking, prescription drug abuse, opiate abuse, emerging trends, etc.

Please fill out the form below to submit electronically, thank you!

Membership Level: Full MembershipWork Group Membership
Coalition:Sussex CoalitionWarren Coalition
First Name:
Last Name:
Title:
Agency or Organization Name:
Address:
Suite, apt. etc:
City:
State:
Zip:
Email:
Phone:
Cell:
Ok to text?:YesNo
Please explain below why you are seeking membership on the Coalition and which sector(s) of the community
you represent (e.g. youth, parent, faith, school, business, local or state government agency, law enforcement
agency, healthcare, other organization addressing substance abuse, family or youth service organization, or
media:)
Please share any special skill, service or area of expertise you or your organization bring to the Coalition: