2023-2024 Durham CoC Membership Form

2023-2024 Durham CoC Membership Form

Online form to submit new or annual CoC Membership Agreement

Email*

First Name*

Last Name*

Registration Date*

Registration Type*

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Member Type*

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If requesting membership for an organization, please include the organization name below

I agree to attend at least one (1) semi-annual meeting of the Durham City and County Continuum of Care.*

I agree to attend a CoC orientation within six (6) months of signing this form.*

I agree to follow applicable CoC Policies and Procedures.*

Identify voting representative and alternate (First and last names)*

Do you have lived experience with homelessness?*

Select

Mailing Address*

City*

Zip Code*

Phone Number*

Do we have permission to list you/your organization as a member of the Durham City and County Continuum of Care and on public materials and websites?*

Select

I and/or my organization agree with and support the goals of Durham’s Continuum of Care which are*

End Chronic Homelessness, End Veterans Homelessness, End homelessness among families, youth, and children, Set a path to end all homelessness

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Electronic Signature*

Please type your name as a record of agreement for this form

Send me a copy of my responses

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