If you support the purposes of this coalition, you can become an Affiliate Member of RVCCC (individual or organization).  For a more detailed explanation of what it means to be an affiliate, click "Become an Affiliate" above. To register as an affiliate of RVCCC, complete the information in this form, then click SUBMIT.

Name of Affiliate       

Affiliate Type Business Educational Church/Religious Other Non-Profit Individual

Contact Person (for business or organizational affiliates):

Mailing Address:

City, State, ZIP:

Telephone:

Email Address:

Web Site (optional):

How did you hear about RVCCC (+ any other comments):

RVCCC internal communications is handled through a Yahoo! email newsgroup.  We will add you to this newsgroup, unless you request not to be added by selecting that option here: YES - add me to the Yahoo! email list NO - do not add me to the email list

We occasionally release public statements or communications.  Please tell us if we need to request your permission each time this is done, or if we may include you as a signatory on any such communications: I/We wish to be a signatory on all RVCCC external communications I/We wish to be a signatory only when express permission is given

BUSINESS OR ORGANIZATIONAL AFFILIATES, please verify that you are authorized execute this affiliation on behalf of the organization by clicking this box: