ADAPT Membership Application

Please help us succeed by joining ADAPT.  You can make a difference in your community!

As a member of ADAPT, you join a group of dedicated individuals performing different tasks to bring population-level changes that will decrease youth access to drugs and alcohol.  We are also striving to be a support system for all Essex County youth, parents, community members, and professionals.

Members are not required to participate in all meetings, activities, or events.  Listed below are the different levels of participation for our members:

  • Active member: You will have the opportunity to join specific Workgroups based on your interest/skillset.  You will also receive meeting invitations, meeting minutes, and informational emails such as notices of upcoming events, meetings, training opportunities, and news alerts on drug and alcohol trends.
  • ADAPT Supporter: You cannot be an active member at this time but would like to serve as a supporter of ADAPT.  This means that you will be a part of our email distribution list, distribute information and material from ADAPT, and provide technical assistance and/or materials related to certain topics that you are privy to.

Please fill out the form below and click Submit when finished.

Your Name*

Your Title*

Your Address*

Your City*
, NJ
Zip Code*

Your Email*

Your Telephone Number*

I would like to be an:
 Active Member ADAPT Supporter

My primary role within the community (community sector) is:
If other, please explain:

My secondary role within the community (community sector) is:  Parent Youth (Under 18) College Student Healthcare Professional Religious Law Enforcement Civic/Volunteer Local Government Fraternal Business Community Youth-Serving Organization Media School
If other, please explain:

I possess the following Skills:  Accounting Computer/Technology Event Planning Graphic Design Photography Strategic Planning Data Collection/Analysis Child Care Filing/Office Work Legal Public Policy/Laws Training/Education Communications Evaluation Grant Writing Marketing/Advertising Public Speaking Web Design
If other, please explain:

I have Contacts that can help the Coalition in the following areas:  Strategic Planning Accounting Computer/Technology Event Planning Graphic Design Photography Child Care Data Collection/Analysis Filing/Office Work Legal Public Policy/Laws Training/Education Marketing/Advertising Communications Evaluation Grant Writing Public Speaking Web Design
If other, please explain:

I have the following Resources to donate to the Coalition:
If other, please explain:

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