Coda Alliance : Organizational Sponsorship / Membership Form

Reasons to join us:

A coalition is an alliance of parties or people created to work toward a common cause. Coda Alliance coalition members work together to identify community needs, develop solutions from multiple perspectives and improve access to quality palliative care and end-of-life services

Benefits for our Sponsors:

* A sponsor link on our website
* Quarterly networking meetings with others who are working to improve end-of-life care including healthcare practitioners, clergy, social workers, health care institutions and hospice professionals
* Quarterly e-mail newsletter updates of events, alerts, and opportunities
* Notification of state, national and local events & policies related to end-of-life issues
* Reduced registration fees at Coda Alliance workshops and events
* Continuing education credits for various workshops

Organization Levels of Support:

____ Coalition Champions - $25,000+ ____ Coalition Leaders - $10,000-$24,999
____ Coalition Underwriters - $1,000-$9,999 ____ Coalition Supporters - $150-$999
____ In-kind Friends

Print this form and fax it to Coda at 408-261-9444.

Contact Person:________________________________________________

Title: _____________________________________________

Organization:__________________________________________________

Address:_______________________________________________________

City, State, Zip:_________________________________________________

Phone:____________________________ Fax: ______________________

E-Mail:________________________________________________________

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Information on this page is provided by Coda Alliance. For more information, visit our website at www.codaalliance.org.