JM4C Coalition - Janesville Mobilizing 4 Change

Community participation is an important part of JM4C’s mission and is necessary for us to be successful.

Become a member of the JM4C Coalition

Membership is available and open to all individuals and groups in Rock County and does not expire.

Membership is divided into two categories:

Coalition Member
- Must complete a coalition membership agreement
- Pledge support to the coalition
- Attend at least half of the monthly coalition meetings held each year
Supporting Member
- Must complete a coalition membership agreement
- Pledge support to the coalition

Name*
First Last
Email*
Enter Email Confirm Email
I would like to become/continue to be a Member of the JM4C Coalition*
By joining, I understand that I will receive meeting reminders and meeting minutes, plus will receive informational mailings such as notices of upcoming events, meetings, training opportunities and news alerts on drug trends.
- I would like to be an Active Member of the JM4C Coalition
- I am unable to be an Active Member, but would like to be a Supporting Member
As a Supporting Member of JM4C, I can provide technical assistance and/or material related to the following topics:
Do you give permission to be identified as a member of JM4C (by name and/or photo) in any print, radio, or television coverage?*
- Yes
- No
Do you know anyone who would make a good member of the JM4C Coalition?
I recommend that you provide JM4C information to the person(s) below. Please provide name, email, phone number or employer/place to contact.
Comments
This field is for validation purposes and should be left unchanged.