Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
*
Are you an existing Partner?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

Organization Name
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
 

What's your address?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
*
Contact Information for Representative #1
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

Job Title
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
 

What's your email?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
*

What's your phone number?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
*
*Contact Information for Representative #2
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

Job Title
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
*

What's your email?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
 

What's your phone number?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
*

Which Partner Level are you applying for?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

Describe your organization. Focus on the "Who, What, Where, When and How."
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

Why do you want to partner with the National Council? (2-3 sentences suggested)
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

What are the most important goals or objectives for your partnership with the National Council? (Please feel free to use bullet points)
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

In your words, how would our members benefit from the National Council's partnership with your organization? (2-3 sentences suggested)
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

What are your current annual sales for the products/services that are directed toward the mental health and addictions field (if applicable)?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

How does partnership with the National Council fit into the larger vision of your organization?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

What are your expectations of the National Council as a Partner? What do you think we can do very well? Where do you think we can help you? (4-5 sentences suggested)
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

What resources do you anticipate devoting to this partnership? What expectations do you have of the National Council? (2-3 sentences suggested)
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
*

Are there any must have's or nice-to-have's that have not been raised thus far? Are there any "no-go" areas for your organization?
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 40 options.
 

Please provide any additional information you would like to share that you haven't already.
Response is required below.
Please enter a valid email address below.
Please enter valid phone number below.
Please select at least no options.
Please don't exceed more than 0 options.
 
Type question here