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Member Interest Survey
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Address
Your answer
Phone number
Your answer
How did you hear about Uplift Irondequoit (Drug-Free Irondequoit Together)?
*
Another coalition member
An activity/event
A social media post
A community poster
Irondequoit Town Hall
My School District
Other:
If you chose other from above, please specify.
Your answer
How would you like to be involved?
*
Would like to be added to the coalition e-mail list.
Would like to attend bi-monthly coalition meetings.
Would like to volunteer for project/events/activities.
Would like to be added to a work group (e.g. DFC Steering, Special Populations Steering, Assessment Committee, Youth Committee)
Would like to offer services or in-kind support.
Other:
If you chose other from above, please specify.
Your answer
Is there anything else you would like to add, or that we should know?
Your answer
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