HTSAC HOMEW & M HOME
Site Administration The College of William and Mary

Membership Application Form

Name
Title
Organization
Address
City
 State Zip Code
Phone
Fax
Email
 Web Site

Check one that best describes your organization

Human Services Criminal Justice Substance Abuse Program
Education Services Faith Based Organization Funding Organization
Corporate Community Local Government Agency Other

I am interested in becoming a member of HTSAC
I am currently a member of HTSAC and would like to renew my membership

Please check the committees you already serve on or are interested in serving on:

Prevention Treatment
Recovery I cannot serve on a comittee but would like to be on the
HTSAC mailing list

In what areas of support can the Coalition assist your organization?

Evaluation Needs Assessment Resource Development
Funding Research Networking & Collaboration

May we include your information on our website? YES NO

 HTSAC Announcements

Your opinions count! The Coalition is busy collecting data on community tobacco use and prevalence and we need your thoughts. Please visit www.htsac.org and click on Community Tobacco Survey to print a copy of the survey. You can also visit, https://www.surveymonkey.com/s.aspx?sm=cy9e1_2bRN34q_2bLQ4muMq9DQ_3d_3d to complete a online version. Feel free to share surveys with your office and neighborhoods. Hard copies of the survey can be returned by mail or fax attn: Nadia Williams
 

Mail to: HTSAC, 161-A John Jefferson Square, Williamsburg, VA 23185 
or 
Fax to: 221-6694

 

 

 

 

 

 

 

 

 

 
 

161-A John Jefferson Square | Williamsburg, VA 23185
757-476-5070 | Fax: 757-221-6694
Email: