Lead Safe Allegheny Coalition Member Commitment
Membership will accepted on a rolling basis and must be renewed annually.
Terms of Agreement
I have received and carefully read the Mission Statement, Vision, Goal, Guiding Principles and Governing Document of Lead Safe Allegheny and have considered not only the literal expression of these documents, but also the intent of each. By signing this affirmation of compliance, I hereby affirm that I understand and agree to comply with the Guiding Principles and articles outlined in the Governing Document.Further, except as otherwise indicated below, I hereby state that I do not, to the best of my knowledge, have any conflict of interest that may be seen as competing with the interests of Lead Safe Allegheny.
Name
First Name
Last Name
Organization Name
Membership Status
Endorsing Member
Supporting Member
Standing Committee Membership
Data and Research
Education and Outreach
Infrastructure
Policy
Signature
Clear
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform