Safe Kids Oklahoma Membership

To become a member, complete this electronic membership form provided below.

Membership Agreement

I agree with the mission of the Safe Kids Oklahoma and its multi-faceted approach to childhood injury: community action, educational interventions, public policy initiatives, and media efforts. I pledge to fight unintentional childhood injury by participating in the coalition.

I understand that acceptance of this application by the coalition does not constitute permission to use the Safe Kids logo, name or materials without first receiving approval from the Safe Kids office **NOTE: the Safe Kids office will not authorize, and will not permit any member of the coalition to authorize, any person or organization to use the name and trademarks to promote its products or services for endorsement or other commercial purpose.

Name:
Title:
Organization:
Street Address:
City, State, & Zip:
Phone:
Fax:
E-mail:
Membership level:

Mail your check to:
Safe Kids Oklahoma
940 N.E. 13th St., Rm. 3N3500
Oklahoma City, OK 73104

All memberships include subscription to quarterly newsletter (Prevention Perspective), listing in newsletter, use of video library, training discounts, and technical assistance. I am interested in supporting the coalition in the following areas: (check all that apply)

As a volunteer, or providing volunteers to help conduct coalition events
Supporting coalition activities with donations of funding and services such as:
Printing coalition materials
Including Safe Kids Oklahoma information in our publications
Providing my materials for distribution through the coalition's activities
Serving on a general speakers' bureau
Serving on a speakers' bureau focusing only on a particular risk area, such as
Mailing information to our members, staff and supporters
Participating in a committee for the coalition (see below-check all that apply):
Would you be willing to serve as a committee chair or co-chair for a one-year term?

To pay with a credit card, please click the PayPal button below: