JOIN THE CAUSE – End Slavery Brevard

MEMBERSHIP APPLICATION

The Space Coast Human Trafficking Task Force is comprised of individuals working as part of a

vetted organization. If you are an individual of a vetted organization and are interested in

membership to the task force please fill out this short membership application. If you have any

questions please feel free to contact us by emailing spacecoasthttf1@gmail.com

Name of Organization:

Name of Representative:

Title:

Type of Organization:

501C3

Other Non-Profit

For Profit

Governmental

Law Enforcement

Social Services

Address

Website:

E-Mail:

Telephone:

What level / type of background screening did you undergo per your organization’s requirements?

Why Are You Interested In Joining SCHTTF?

Types of Services Provided By Your Organization:

Eligibility Requirements For The Services Provided By Your Organization:

Will These Services Be Available To Victims of Human Trafficking? Please Explain:

Which Committee(s) Are You Interested In Joining?

·Training & Outreach

·Victim Services

·Faith Based Organizations

·Law Enforcement & Judicial (closed group)

I certify that the information given above is true and accurate.

I understand that if accepted into SCHTTF, I must not act in SCHTTF’s behalf without written

authorization from the Committee.

I understand that membership in SCHTTF does not imply approval or endorsement of individual

organizations’ activities or positions.

I understand and respect the confidential nature of the information I might receive as a member of

the SCHTTF.

I agree to undergo background screening, if needed and not already completed as part of my

organization’s requirements.

Signature of Applicant: ___________________________________________________

Date: _____________________________

Signature of Applicant’s Direct Manager: ___________________________________________

(Approving applicant’s participation in the SCHTTF)

Date: ____________________________