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Chippewa County CTC Interest Form
To learn more about our coalitions and how they work, visit
www.UPCTC.com/members
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* Indicates required question
Name
*
Your answer
Phone number & email
*
Your answer
How do you want to support the coalition?
*
Join a work group
Help out at events
Pass out materials in the community
Other:
Required
How did you hear about our coalition?
*
Word of mouth
Social media
Radio/TV/newspaper
Friend or family member
Other:
Required
Do you have a friend you think we should invite to the coalition? (Include name & contact info)
Your answer
Do you have any comments or questions?
Your answer
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