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Sign up as a member of the SAFE Coalition Now
“Seatbelts
Are For Everyone”
Mission:
The mission of the SAFE Coalition is to increase seatbelt use
among all residents in Massachusetts and to reduce motor vehicle related
fatalities and injuries and its corresponding costs by upgrading the
current seatbelt law.
Member
Form
Name:____________________________________________________________
Check
Which Applies: ___
Individual ___
Business ___ Organization
Mailing
Address:____________________________________________________
City:___________________
State:__________________ Zip:________________ Name
of Responsible Person signing (please print):_________________________
Title
of Responsible Person signing:_____________________________________
Signature
of Responsible Person/home town:_____________________Date:_____
Number
of members in your organization:_________________________________ Contact
person in your organization/home town:____________________________
Your
Spokesperson (if different from contact):______________________________
Phone
number:_______________________________________________________
e-mail
address:_______________________________________________________
Fax:________________________________________________________________ Activity
Level
Writing
testimony:_______________________________
Offering
testimony at hearings:_____________________
Attending
organized visits with legislators:____________
Writing
or calling legislators:_______________________
Publishing
written articles in your newsletter:__________ Linking this coalition to your web page:_______________
Coalition
Coordinators |