Apply to become an IMCHC member now!

" Transforming maternal and child health in the 21st century "

As we launch our new Campaign to Save Our Babies, I invite you to become a member, an integral part of the IMCHC family, and to contribute your efforts to improving the lives of children and families in Illinois. Your membership allows us to promote policies to encourage maternal and child wellness at the local, state and federal level and provide educational forums on cutting-edge research and practice.

By sending in your IMCHC’s membership, you have the ability to:
· Be part of a collective voice for public policy and advocacy and benefit from the use of CapWiz, an advocacy tool that allows you to send an email to your legislators;

· Network with other maternal and child health advocates;

· Gain access to member-only benefits such as advocacy trainings and special events;

· Receive a bi-weekly electronic newsletter;

· And obtain discounted registration for IMCHC sponsored conferences and seminars.

Please become a member today. The Coalition needs your continued support and membership to ensure that we are successful in building a movement to support health equity for all women and children.

NEW OR RENEWAL MEMBERSHIPS

Become a Member Now!

Organizations or individuals who want to join the Illinois Maternal & Child Health Coalition should complete our membership form below. All membership applications are reviewed by the IMCHC Board of Directors and are subject to approval. For more information on membership, contact Lilah Handler at 312.491.8161 or ilmaternal@ilmaternal.org.

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

SALUTATION

FIRST NAME:

LAST NAME:

ORGANIZATION/ AGENCY NAME:

TITLE:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE:

FAX:

WEB SITE:

EMAIL:

Please volunteer for one or more of the following committees:

Campaign to Save Our Babies

Chicago Area Immunization Campaign

Illinois Coalition for School Health Centers

Illinois Premature Infant Health Network

Covering Kids and Families/Health Care Reform

IMCHC Board Committees:

Fundraising Committee

Marketing Committee

Program/Policy Committee

Junior Board (for young professionals)

Please identify which chapter you would like to join:

		Chicago
		Lake County
		Southern Illinois (Mt. Vernon)

Enclosed are dues in the amount of:

Based on Your Annual budget/ Revenues**

* Fees may be waived upon request.
** Organizational members can register up to three individual members from
their agency/business. Please submit one form per member.
*** Sponsoring Organization can register up to ten individual members from their
agency/business. Please submit one form per member.

Thank you for your continued support!

ilmaternal@ilmaternal.org

Tel: 312.491.8161

Fax: 312.491.8171

Illinois Maternal & Child Health Coalition

1256 W. Chicago Avenue

Chicago, IL 60622