Illinois Coalition for School Health Centers

 

" Keeping Students Healthy and Ready to Learn "

 

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MEMBERSHIP FORM

 

Please fill out and return to us for a one-year annual membership. Dues information is located at the bottom of the page.

NAME:

TITLE:

AGENCY:

ADDRESS:

CITY:

STATE:

ZIP CODE:

TELEPHONE:

FAX:

EMAIL:

 

Please volunteer for one or more of the following committees:

Program Development and Evaluation
Public Policy and Advocacy
Mental Health

 

Enclosed are Dues in the amount of: (check one)

Individual $30.00
Organizational $100.00
Organizational (Budgets less than $200,000) $50.00
Student (need proof of enrollment) $15.00

 

MEMBERSHIP DUES: $
TOTAL*:

$

* Please make checks payable to Illinois Maternal & Child Health Coalition

 

 

Print this page and mail it with check to:

IMCHC/SBHC

1256 W. Chicago Avenue

Chicago, IL 60622

312.491.8161 (phone)

312.491.8171 (fax)

 

THANK YOU!

 

School Health Centers Summary  |  About Us  |  School Health Center Locations  |  Events

  Meeting & Training  Dates  |  Publications  |  Related Resource Links

Join Us  |   Locate Us  |  Contact Us  |  Illinois Coalition for School Health Centers Homepage

 

 

IMCHC HOMEPAGE

 

CHICAGO-AREA IMMUNIZATION CAMPAIGN

 

COVERING KIDS & FAMILIES ILLINOIS

 

CLOSING THE GAP/ SAFE MOTHERHOOD INITIATIVE

 

 

icshc@ilmaternal.org

Tel: 312.491.8161

Fax: 312.491.8171

Illinois Coalition for School Health Centers

1256 W. Chicago Avenue

Chicago, IL 60622

 

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