Member Contact Information

Welcome to the Resilient Middle Georgia Coalition Membership! We're thrilled to have you join us as a partner in our mission to cultivate resilience in our region. In this form, please provide your organization's contact information and sign our coalition commitment letter to officially become a member of the coalition.

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* 1. Contact Person (First and Last Name)

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* 2. Role/Title

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* 3. Phone Number

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* 4. Email Address

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* 5. Organization Name

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* 6. Organization Website (if applicable):

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* 7. Counties Served

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* 8. What category best represents your organization? (Check all that apply)

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