New Applicant Form

Alliance for Community Transformations
C/O The Lightning Jar
194 North St
Bennington, VT 05201
(802) 442-0713 x9
ACTBennington.org

Name(required)

Address(required)

Email(required)

Phone(required)

Company(required)

Title(required)

What is your preferred method of contact to receive news and information about events from ACT?

Other

Organization/Program Name

Organization/Program Website (If Applicable)

Which sector best describes your organization or program(required)

Other (please specify)

Thank you! If you have a moment check out some resources for new members.