Membership Form - Join the Conversation

Organizational Membership Form

Eliminating stigma is a no easy task. It will truly “take a village” to create permanent change. The Erie County Anti-Stigma Coalition is looking to expand its membership. We ask that you consider becoming an organizational member of the coalition in support of this monumental effort. In order to become an organizational member, please complete this form and include a brief statement from your CEO or Executive Director on why you want to join the coalition and we will add you to the letstalkstigma.org website.

Prefer to fill out and send via email? Download a PDF version here and email to mike@letstalkstigma.org.

"*" indicates required fields

Name of Organization*

Contact Person*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

CEO Statement*

CEO Name & Title*

Please provide a brief description of your organization.*

Website*

Please indicate below the way(s) your organization would be able to assist in this important work.

A member of the coalition will follow up with you (or your designated contact person) in a few days to answer any questions and get you on board.

Sign the campaign pledge and get others to do the same (i.e., employees, supporters, clients, vendors, etc.)

Share the Join the Conversation logo, website (LetsTalkStigma.org) and social media links on your website

Display “Take the Pledge” table card and share other Join the Conversation handout materials in your public work areas

Interested in being part of a volunteer speakers bureau (on topics relating to mental health and reducing stigma)

Willing to serve on a coalition committee

Have a project in mind that might help spread the word

Willing to sponsor specific project(s) or special event(s)

Know others who may be interested in working with the coalition

Willing to do more

Please Upload a copy of your logo*

PNG with transparent background preferred.

Max. file size: 50 MB.

Willing to do more? Please let us know what you can do.

Know others who may be interested in working with the coalition? Please add their emails below

Name

Organization

Email

Thank you for your support. We look forward to working with you and having your organization join this important conversation.