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Allegheny County
Coalition for Recovery
  GETTING INVOLVED FORM  

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Name:
Address:
City, State & ZIP:
Phone: Daytime:       Evening:
 
May a message be left at the daytime phone number?     Yes:     No:
May a message be left at the evening phone number?     Yes:     No:
 
Email Address:
 
  Interests (Please check all that apply):

  Volunteering to work at the ACCR event indicated below
  Un-Dependence Day (July 7, 2007)

  Join the Speakers' Bureau on the topic of    
        (A one-time, two-hour training session will be offered.)

  Serve on the ACCR committee indicated below
Child and Family Education Public Awareness Quality Improvement
 
Please fill in this form and press the submit button
or print out the form, fill it out and send it through the U.S. Mail to:
ACCR
c/o PSAN
938 Penn Avenue
Pittsburgh, PA 15222
Thank You

 
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