Essex County Cancer Coalition

Become a Member
Last Name First Name Middle Initial
Organization (optional) Title (optional)
Street Address City
State Zip Code
Telephone (daytime) Fax
Email address
Is the above contact information for home or work?
Are you a: (check all that apply)
Cancer Survivor/Person Affected by Cancer
Family Member of Person Affected by Cancer
Cancer-Related Researcher
Advocate
Healthcare Professional
Education/Outreach Provider
Education/Outreach Provider
Student
Other
Are you already a member of the ECCC?
Are you a member of the Essex CEED Coalition (which meets jointly w/ the ECCC)?
If NO, how did you hear about the Essex County Cancer Coalition (ECCC)?
Please describe any special knowledge or expertise in diagnosis or treatment of a specific cancer or in cancer clinical trials that you have:
How do you wish to contribute to the efforts of the ECCC?
Check which committee(s)/group you are intersted in: (please see descriptions)
Advocacy Development
Education/Outreach Clinical Advisory Group
For purposes of advocacy as well as to ensure adequate representation of the entire county it may be helpful to know which legislative districts and municipalities members reside in.
Do you live in Essex County?
If yes, list your municipality
And check your district/legislators (if you are not certain please refer to the list below for areas in each district):
District 21 (Senator Thomas H. Kean, Assemblyman Jon M. Bramnick and Eric Munoz)
District 27 (Senator Richard J. Codey, Assemblyman Mims Hackett Jr. and John F. McKeon)
District 28 (Senator Ronald L. Rice, Assemblyman Craig A. Stanley and Donald Kofi Tucker)
District 29 (Senator Sharpe James, Assemblyman Wilfredo Caraballo and William D. Payne)
District 34 (Senator Nia H. Gill, Assemblyman Peter C. Eagler and Assemblywoman Sheila Y. Oliver)
District 36 (Senator Paul A. Sarlo, Assemblyman Paul DiGaetano and Frederick Scalera)
District 40 (Senator Henry P. McNamara, Assemblyman Kevin J. O'Toole and David C. Russo)


District by Number for Essex County Municipalities
(For districts of municipalities outside Essex, see Legislature page
District 21
Millburn Township

District 27
Caldwell Township
Essex Fells Township
Fairfield Township
Livingston Township
Maplewood Township
Newark City (partial)
North Caldwell Township
Orange Township
Roseland Borough
South Orange Village Township
West Caldwell Township
West Orange Township

District 28
Belleville Township
Bloomfield Township
Irvington Township
Newark City (partial)

District 29
Newark City (partial)

District 34
East Orange City
Glen Ridge Township
Montclair Township

District 36
Nutley Township

District 40
Cedar Grove Township