APPLY FOR MEMBERSHIP Entity/Individual Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Website I consent to my website being listed and linked on CoC website's provider list Yes No I'm applying on behalf of: * Individual Entity On which of the following committee(s) would you or your entity prefer serving? System Performance Committee Program Performance Committee Service Delivery Committee Governance and Membership Committee Advocacy Committee Consumer Council HMIS Committee Coordinated Entry Commitee Membership Acknowledgement I acknowledge that for my membership to be considered in good standing, I must meet the CoC by-laws definition of Active membership under Article III, Section 2 or Affiliate membership under Article III, Section 7. I also acknowledge that I have read the Member Qualifications, Duties and Responsibilities and I agree to abide by them. Yes Thank you!
