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Home > JOIN US > SWC Member Agreement

About SWC Membership

SWC memberships are individual memberships, open to all, and free of charge. Individual members may or may not represent an organization. A separate Organizational Partner Agreement is applicable for organizations that support the SWC vision and mission.

Vision

The SWC is committed to a safe, secure, healthy, prosperous and drug free community.

Mission

Collaborating with local resources and partnerships to foster wellness and a drug-free community for our youth, adults and families.

Member Information for SWC Communications

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address City State ZIP Code

Phone #1(Required)

Is this phone number:(Required)

Cellphone

Work phone

Home phone

Phone #2

Is this phone number:

Cellphone

Work phone

Home phone

Employer/Organization

If representing your employer or other organization

Title

I am interested in SWC involvement because ...(Required)

Talents, skills, and resources I and/or the organization I represent may offer SWC(Required)

(ex: professional or technical expertise; boost publicity and events promotion; financial support or in-kind match for grant funding; access to relevant data; volunteer time)

What can SWC do to help you and/or the community group(s) or organizations you are involved with?(Required)

Please select all SWC-relevant community sectors I am part of:(Required)

Youth

Parents & Parenting Role

Business & Business Community

Media

School or Educational Organization

Youth Serving Organization

Law Enforcement Agencies

Religious or Fraternal Organizations

Civic or Volunteer Organizations

Healthcare Professionals and Organizations

State, Local or Tribal Government Agencies

Human Services

Substance Abuse Organizations - Prevention, Treatment and/or Support

Concerned citizen not affiliated with a particular category above

Age if 21 or under

Southside Wellness Coalition agrees to:

Facilitate development and adherence to SWC by-laws and policies.
Oversee development, implementation, and ongoing evaluation of strategic action plans that advance the SWC mission and vision.
Ensure compliance with the terms and reporting requirements of all funding sources, including documentation and secure storage of SWC records.
Pursue a credible and relevant sustainability plan which includes financial, material, volunteer and in- kind resources.
Support member development with opportunities to network, learn, and participate in SWC activities and coalition development.
Respect the rights of SWC members to hold their own opinions and beliefs.

SWC Member agrees to:

Support SWC values by acting as a role model for youth, families, and peers.
Participate in SWC development, strategic planning, and activities through SWC meetings (held monthly), Work Groups, and special events. Maintain familiarity with SWC through the SWC website and other member communications.
Share SWC materials, social media posts, and event promotions through personal contacts and community or organizational groups as relevant.
Document SWC time and contributions as match for grant funding as allowed.
Renew and update the SWC membership form at least annually.

By entering my name below, member acknowledges email will be added to SWC emails, and that email and phone # may be shared with SWC members and others for SWC mission related communications. Member name, and affiliate organization if provided, will be published on the SWC website and within other SWC communications. Contact information will not be otherwise shared by SWC without separate permission.

Name(Required)

Date(Required)

MM slash DD slash YYYY

Name of Organization Represented

Date

MM slash DD slash YYYY

Contact

143 Industrial Parkway Clarksville, VA 23927

434-202-5450

info@bewellsouthside.org

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