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Sample Coalition Enrollment Form

You can use this form to sign up members for your coalition.

Yes, my organization strongly supports the viability and expansion of public transportation in our community! We support increased funding for public transportation and would like to participate in the coalition’s efforts. Please add our organization’s name to the [insert name of coalition]’s membership list. We understand that there is no financial obligation connected to our enrollment and our participation is voluntary.

Organization:____________________________________________________

Contact Person / Title:_____________________________________________

Signature:_______________________________________________________

Street Address:__________________________________________________

City / State / ZIP:________________________________________________

Phone Number:__________________________________________________

Fax Number:_____________________ E-mail__________________________

Preferred method of communication:_________________________________

Please indicate the activities in which you or your organization is most interested:

Communicating with local officials (through meetings, letters, and telephone calls)

Communicating with the media (through interviews, meetings and briefings)

Communicating with the public (through speeches or presentations to local groups)

Participating in public events, such as government hearings and press conferences

Providing the following in-kind contributions or support: _______________________________________________________________

Other activities: ______________________________________________