Member Application

Date of Application
Organization
Geographic Focus (Check all that apply):
- Local
- State
- National
Are you a chapter or an affiliate of a statewide or national organization?
- Yes
- No
If yes, please state your chapter or affiliate name.
Contact Person/Representative to CaCCR:
FirstLast
Title
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Email
Website
What is the mission of your organization? Please include a brief overview of your primary programs, activities and goals.
Please briefly describe why your organization is interested in joining CaCCR and how you hope to participate in the coalition. For national organizations: you must have members or constituencies in California who will actively support CaCCR activities at the state policy level.
Any other comments you would like to share?
My Organization is dedicated to moving forward a progressive civil rights agenda that advances the health and well-being of every Californian and our planet. This vision includes, and is not limited to, quality education for all, meaningful employment, affordable housing, access to health care, secure neighborhoods, a fair criminal justice system, economic equity, increased opportunities for disadvantaged communities, and a populace, government and a business community sharing responsibility to ensuring a healthy environment for our current and future generations.*
- We agree with this statement.