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Concord Substance
Abuse Coalition
46 South Main St.
Concord, NH  03301

(603) 223-2023
fax:  (603) 228-0395


 
 

Membership Application

At the Concord Substance Abuse Coalition, we understand the value or time, especially yours.  Each hour your give is important to us and very much appreciated.  No matter the degree of your involvement, we thank you for choosing to become a community leader for the prevention of substance abuse and underage use.

Last Name: 

First Name: 

Address: 

City: 

State: 

Zip: 

Phone: (enter as 123-456-7890) 

Fax: 

Email: 

How Did You Learn About The Coalition? 

Position/Title: 

Name of Organization: 

Organization Type: 

 
 

As a Coalition Member, you will receive information on upcoming training sessions, seminars, volunteer opportunities and Coalition activities.  You will also belong to a group of concerned citizens who care about the health and well-being of our community.