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JTNN Coalition Membership Form

Join Together Northern Nevada Coalition Membership Form

This form is to assist JTNN in affirming partnership, tracking demographic participation, tracking sector participation, and gathering up to date contact information to ensure meaningful communication.

1. Name

2. Email

3. Organization

4. Job Title/Position

5. Do you currently serve on any of the JTNN Committees? (Mark all that apply)

Environmental Strategies
Prevention/Opioid
Overdose Awareness Day
RX Take Back Days
Other
None

6. Are there any committees you wish to participate in?

Environmental Strategies
Prevention/Opioid/Polysubstance
Overdose Awareness Day
RX Take Back Days
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

7. Which community sector do you represent?

Please enter an 'other' value for this selection.

8. What are your needs as part of the coalition?

9. Where do our missions and interests intersect in the community? How can we collectively impact substance misuse in partnership?

10. How often/how in depth would you like to see future All-Coalition Meetings?

2 Hours; Quarterly
Full Day; Twice a Year
1 Hour; once a month

11. What would you like to see included in All-Coalition meetings?

12. Would you like to receive the JTNN Newsletter?

Please email Anne-Elizabeth Northan, Executive Director, Join Together Northern Nevada for more information, to join committees, to volunteer, or for additional data sharing.

director@jtnn.org