Become a TLC Member!  Download and fill out this form (word doc) and mail it to us at Tobacco-Free Lavender Communities 621 West Lake Street, Suite 205 Minneapolis, MN 55407, or send us your information and signature however is convenient to you by using this template:

Tobacco-Free Lavender Communities of Minnesota (TLC)

Member Information Form

Thank you for taking the time to complete this informational form. This is information will provide TLC with updated contact information for your organization, as well as assist us in recommending your organization to interested parties. It will also help us establish a resource and link list for the TLC website.

Organization Name:

Address:

Phone:

Website:

Contact Person:

Email:

1-2 Paragraph Description of Organization (mission, goals, services, etc…):

________ TLC has permission to include this organization’s information on the TLC website.

________ TLC does not have permission to include this organization’s information on the TLC website.

_______________________________________________________ ______________________

Signature Date

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Printed Name