ACCR Getting Involved Form

Allegheny County
Coalition for Recovery

GETTING INVOLVED FORM

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