To solicit commitments and ensure active participation from those people interested in starting a state-wide organization, you can ask each member to complete a “commitment card,” such as the one below. The card enables members to provide contact information, indicate their level of interest, and articulate their philosophical support for the mission of the organization.

Name:                           Agency Affiliation:
Address:
City:                             State:                Zip:
Phone: (Home)                Work:                Fax:
Cell:                              E-mail:   

_____    I am interested in serving on the board of the organization.

_____    I am interested in a leadership role as:

I support the need for prevention in our state with my contribution of
[ ]$10    [ ] $20    [ ]$30    [ ]$50    [ ]$100    [ ]$Other

_____ I support the need for prevention, but can’t be actively involved at this time.

I support the following prevention strategies in our state (Please check all that apply):