Membership Form

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If you are interested in becoming a member the Alliance then you or another representative of your organization must have attended at least one Alliance Meeting and agree to the vision and goals of our organization. The Alliance holds three meetings per year: the Annual Conference and a fall and summer meeting.

Authorized Representative: *

Representative of the organization requesting membership

Organization Name: *

Name of Organization requesting membership

In support of this request, I certify...: *

That I am an officer or other duly authorized representative of the above-named organization

That representatives of this organization or agency have attended one or more meetings of the Alliance since the initial meeting in March2002

That this organization or agency is interested in and supportive of the mission and goals of the Alliance, and thus qualifies for enrollment as a Member.

Date: *

Mailing Address Line : *

Email Address: *

Phone Number: *

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Membership Form PDF	13.26 KB

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