Bristol County Regional Alliance - Membership Registration

Registration Page

The Bristol County Regional Alliance to End the Opioid Crisis a group of individuals and organizations dedicated to collaboration, communication, and networking with area stakeholders. Membership is open to all individuals and organizations interested in adhering to our guiding principles outlined on our website.

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* 1. First Name

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* 2. Last Name

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* 3. Title

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* 4. Organization

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* 5. Contact Phone Number

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* 6. Contact E-mail

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* 7. Please select your top area of interest with regard to addressing the Opioid crisis.

Prevention

Intervention/Harm Reduction

Treatment

Recovery

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* 8. Which sector best describes your work?

Business

Community Organization/Fraternal Organization

Education

Faith

Faith Community

Government

Healthcare Provider

Law Enforcement

Media

Parent

Substance Use Disorder - Treatment Provider

Youth

Youth Serving Organization

Other (please specify)

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* 9. Please select the top two reasons you are interested in the Bristol County Regional Alliance (Select 2)

Networking with other people doing this work

Developing a County-wide workplan

Gaining education about subjects related to the opioid crisis

Access to County-wide data

Sharing what your community/organization is doing related to the opioid crisis

Resource development (time, talent, treasure)

Sharing Best Practices

Other (please specify)

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* 1. First Name

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* 2. Last Name

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* 3. Title

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* 4. Organization

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* 5. Contact Phone Number

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* 6. Contact E-mail

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* 7. Please select your top area of interest with regard to addressing the Opioid crisis.

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* 8. Which sector best describes your work?

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* 9. Please select the top two reasons you are interested in the Bristol County Regional Alliance (Select 2)

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* 10. What would you like organizers of this group to think about when planning the Alliance's workplan?