OD Free Marin Collaborative Membership
Please complete this member registration form. Thank you for joining OD Free Marin!
Question? Visit our website: https://odfreemarin.org or email us: info@odfreemarin.org
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Please select the sector(s) you best represent as a subject-matter-expert or person with lived experience:
*
Parents/Guardians
Youth/Students
Media/Marketing
Schools/Academia
Youth Serving Organizations
Justice Systems/First Responders
Volunteers/Civic/Non Profit
Faith-Based Organization
Healthcare
Local Government
Harm Reduction Advocates
People with Lived Experience (ie recovery, overdose, survivor, drug user)
Subject-matter Experts (ie epidemiology, homelessness, SLE)
Substance Use Treatment Providers
Name of your organization, school, or affinity, if applicable:
Please select your preferred membership level: (Choose One)
*
GENERAL COMMUNITY MEMBER: I would like to be invited to attend public events, have the option to respond to calls for action, stay updated on overdose prevention efforts in Marin through OD Free Marin's newsletter, social media, and website. I may sign up for volunteer opportunities. (If you choose this option, you can now submit this form. No need to answer any additional questions below. Thank you!)
ACTIVE COLLABORATIVE MEMBER: I intend to participate regularly on an Action Team or the Advisory Committee, to be involved with planning and implementing strategic initiatives, act as an ambassador for ODFM in the community, join working groups of interest, in addition to enjoying all the engagement options of a General Community Member. (If you choose this option, please continue to answer the remaining question on this form to select an Action Team. Thank you!)
I am not sure and need to learn more. (Please visit https://odfreemarin.org/action-teams/ to learn more or reach out to discuss your options: info@odfreemarin.org -Thank you!)
I no longer wish to be/can be a member of OD Free Marin. Please remove me from all lists and mailings. Thank you. (If you choose this option, you can now submit this from. Thank you.)
Active Collaborative Members, please choose an Action Team to join and participate in regularly (Please choose only one):
Education & Outreach Action Team (Focused on promoting and providing overdose prevention information, trainings, education, resources, and advocacy across Marin). Media, marketing, strategy and education professionals encouraged. Event and training volunteers appreciated.
Intervention, Treatment & Recovery Action Team (Focused on initiatives supporting access to treatment and a broad range of recovery resources). Healthcare, harm-reduction, treatment professionals encouraged. Lived experience appreciated.
Youth Action Team (Youth led and directed team that is focused on supporting youth through outreach at schools and through peer-to-peer education). Adult allies welcomed particularly professionals supporting youth health and wellness.
I am not currently interested in being part of an Action Team.
If selected Youth Action Team, are you of the youth age range (9-25)?
Yes
No
If yes, which school do you attend and grade level? Put N/A if this does not apply to you.
Thank you. You will hear from OD Free Marin in the coming week(s) to learn about next steps and ways to get involved. We look forward to working with you! Questions? Please email us at info@odfreemarin.org
Please visit our website: https://odfreemarin.org to learn more about OD Free Marin - Marin County's overdose prevention collaborative.
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