Northwest Suburban Alliance on Domestic Violence

Northwest Suburban Alliance on

Domestic Violence

15 W. Weathersfield Way
Schaumburg, IL 60193
ph: (847) 923-9104
fax: (847) 923-9104

New Members

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*First Name:

*Last Name:

*Agency Name:

Agency's Address:

City:

State/Province:

ZIP/Postal Code:

*Phone Number:

*Email Address:

Contact Preference:

Join Mailing List?

Please add me to your mailing list.

How did you learn about the Alliance?

Please describe your experience on any other boards (past or present). How long did you serve, type (corporate or non-profit)?

Please describe your role and your experience.

What skills and/or experience do you want to share with the Alliance?

a) Are you willing to be a part of our speaker’s bureau?

b) What is your area of expertise?

List any specialized training and/or certification?

Do you feel you understand the mission of the Alliance?

Which sub-committee would you be interested in participating?

The Alliance values membership attendance at meetings. Do you anticipate any professional or personal commitments that may prevent you from attending the meeting?

What services does your agency/business offer for cases of domestic violence?

Please let us know how we may be of any further assistance to you.

Submit Your Form:

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15 W. Weathersfield Way
Schaumburg, IL 60193
ph: (847) 923-9104
fax: (847) 923-9104