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Hialeah Community Coalition, Inc. Membership Application Form

The HCC seeks members from a variety of community sectors to work together reduce children’s substance abuse. The HCC MISSION is: “Together the Hialeah Community Coalition Inc. and its partners will create a healthy community through education, prevention and increased awareness of drug use and underage drinking”.

The role of coalition members is to support the mission. Members serve at the discretion of the HCC, Inc. and pledge to attend and participate regularly. Members are individuals of good standing in the community who are willing to participate in making the Hialeah community a place where children are healthy, safe and drug-free.

I understand the role of a member of the HCC, Inc. I am interested and pledge to participate in the HCC, Inc. as a member to help prevent and reduce youth substance abuse and underage drinking in Hialeah.

Name *

Telephone

Address *

Street City State Zip

Email *

Institutional Affiliation and Role

Community Sector: Please select the primary sector you represent.

Youth
Parent
School
Business
Law Enforcement
Religious/Fraternal Org
Civic/Volunteer
Media
Healthcare
Youth Org
State/Local Govt
Other Substance Abuse Org

PARTICIPATION PREFERENCES - I would like to: (Please check one or more of the following.)

Help with preventions activities such as town halls, focus groups, and presentations.
Assist in implementing universal prevention campaigns such as Red Ribbon, Family Day, etc.
Help with prevention strategies in the schools.
Serve on the Youth Leadership Team and help spread prevention messages to my peers.
Help enforce laws to prevent underage drinking.
Help the coalition develop more resources and capacity.
Assist in monitoring coalition progress and assessing the coalition’s impact.
Other – What other way would you like to help?

If you have questions or need more information please call Liz Garcia at: 305-785-6969 or email: liz@hialeahcc.org

Our mission is to serve as a community coalition dedicated to the comprehensive & long-term reduction & prevention of underage drinking, substance use & abuse of drugs; while working in partnership to create a safe, healthy & drug-free Hialeah community.

4708 East 9 Lane Hialeah, Florida 33013
info@hialeahcc.org

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