Drugs Don't Work Enrollment Request

Upon completion of the Drugs Don't Work Enrollment Request, you will be contacted by the Robins Regional Chamber DDW Coordinator with additional documents and payment information to complete your enrollment in the Drugs Don't Work Program. DDW membership is included at no additional charge with most chamber membership packages. Please allow 2-3 business days to respond your request. For immediate assistance, please contact Aura Lee Durham at aduhram@robinsregion.com or 478-922-8585.

*Completion of this form is a request only and does not guarantee Drugs Don't Work Membership. DDW Membership is contingent upon Chamber Membership.

ABOUT YOUR BUSINESS

Name of Business *

Business Location

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Phone Number *

E-mail Address *

Is this business a current Robins Regional Chamber Member? *

Yes No I do not know

CONTACT INFORMATION

Drugs Don't Work Point of Contact

Title

First Name *

Last Name *

Suffix

E-mail Address *

Office Phone Number *

Cell Phone Number

Mailing Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Drugs Don't Work Enrollment Request

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