I want to help in the following area(s):                             I am willing to:

   Prevention in schools                                          Attend meetings     

   Parenting & family education                                Prepare, review or edit materials

   Youth activities                                                   Assist with special events & forums

   Recovery advocacy                                              Serve as a speaker at groups or on TV

   Healthcare                                                         Visit classrooms, talk with students

   Senior issues                                                     Assemble data on trends & impacts

   Drug Free Workplace                                           Promote SCoSA activities

   Drug Free Schools                                               Work with doctors, nurses, etc.

   Public policy                                                       Make a donation to SCoSA

   Community public awareness                                Other

   Events coordination

   South County SCoSA activities                             How many hours a month can you contribute

   Fundraising                                                       to SCoSA activities?  

   Other 
 

    Name:      

     Address:  

     City:           State:    Zip: 

     Phone:        Fax:   

     E-mail: