Merrimack Valley Substance Use Disorder- Resource Guide Entry

This document is a compilation of Substance Use Disorder efforts throughout Merrimack Valley. We hope that through this effort we will continue to learn more about what services are available, work towards eliminating silos, and coordinate services across the communities. If you would like to have your agency, program, or service added, please fill out the form below. Thank you!

MVSUD Summit Resource Guide Application

Please fill out the following application so that your agency's information can be included in the Merrimack Valley Substance Use Disorder Summit Resource Guide. Your application will be reviewed by the committee before addition to the resource guide. Completion of this application DOES NOT count as RSVP for the event.

"*" indicates required fields

Organization Name*

Department Name*

Address (Please include street name, building # (if applicable), town/city, state, and zip code)*

Website (if applicable)

Will your agency be attending the Summit on December 12, 2024?

Yes

Please only choose ONE response.

Will your agency be attending as a vendor?

Yes

Please only choose ONE response.

Contact Information

Please provide the information for the point person of contact at your agency.

Contact Person*

Contact Email*

Contact Number*

Agency Description

Service Category*

Please choose one.

Agency Description*

Describe the services your organization provides in 250 words. Please include the following information: catchment area, population served, detailed description of services provided, and a description of how to access services.

Agency Logo

Accepted file types: jpg, png, Max. file size: 128 MB.

Please provide your agency's logo (if applicable).