Become a Member of Heroin Action Coalition


Become a Member of Heroin Action Coalition of Maryland
(Instructions: Copy and paste the information below to your email program.)

Name:
Address:
Phone:
Email:

Check all of the following that apply:

__ I would like to attend monthly policy meetings
__ I would be willing to share my story about my own recovery or that of a family member with legislators
__ I would be willing to volunteer for various projects
__ I am interested in attending a support group and am currently in recovery
__ or I am a family member of an addict
__ I am currently using opiates and need help getting treatment
__What County do you live in? (We can direct you to your closest county advocate)
__ I would like to be a support to the work and give a monetary donation:
$20        $50           $100           $500        other

Return this form by copying it to your email program and filling in where appropriate:

Send to: HAC Director, Lisa Lowe at lisa.lowe@heroinactioncoalition.com

To Donate:
Make checks payable to: Lisa Lowe, Heroin Action Coalition
Or use our PayPal Link to donate by credit card
Have questions? Contact Us at 301-525-6183

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