Become a member - Alliance for Healthy Communities

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Become a Member

Thank you for your interest in becoming a member! Please help us to learn more about yourself and your interest in our organization.

ASAP Membership is voluntary and free. The following information will be kept confidential and only used by Coordinator, Chairperson, and/or committee chairs to maximize our prevention efforts in Pasco County.

Name *

First

Last

Email *

Business/Organization/Affiliation:

Street Address

City

State

Zipcode *

Phone Number

Please select the programs and/or committees in which you would like to participate (Note: you can be a member even if you cannot attend the meetings). *

Alliance for Healthy Communities (AHC)
Alliance for Substance Addiction Prevention (ASAP)
STAND Above the Influence
Substance Exposed Newborn Committee
Prescription Drug Committee
Alcohol Initiatives Committee
Recovery Committee

I represent the following groups: (Please select up to 2 options) *

Parents
Youth
Business community
Civic/volunteer groups
Healthcare professionals
Law enforcement agency
Media
Religious/faith-based community
Schools
State, local, or tribal agencies
Youth service agencies
Substance addiction agency
Other:

Please enter your group for "Other" *

Help us find a fit for your talents and interests: (Check any interests or skills you’d like to apply)

First Choice
Working with youth
Event Planning/Management
Recruiting community members
Marketing/advertising/PR
Internet social networking
Program planning
Evidence Based Practices
Laws/Policy/Legislation
Research/Data
Volunteer management
Politics
Newsletter writing
Advocacy
Community connections
Fundraising
Group facilitation/training
Grant writing
Community presentations
Working with parents
Other:

Please enter your talents and interests for "Other" *

Please list any groups, associations, or organizations you are part of and which may be interested in learning more about drug and alcohol prevention (Example: HOA, sports team, local non profit, volunteer program, church group, Chamber of Commerce, etc.).

Please write how we can serve you and your work/interests.

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