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Membership Worksheet FY2023
This form will be sent out annually to update coalition records. Questions? Email ranton@pchares.org
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* Indicates required question
What is your name?
*
Your answer
What is the best email to contact you at?
*
Your answer
What is your work phone number?
*
Your answer
Which sector best describes your current role?
*
Business
Civic/Volunteer Group
Schools
Local Government
Health Care Professional
Law Enforcement
Media
Parent
Religious/Fraternal Organization
Youth (under 21)
Community member (over 21)
Youth Serving Organization
Other:
What is the name of your organization?
Your answer
Which location is closest to your home/office/service area?
*
Bedford Park
Bridgeview
Brookfield
Burr Ridge
Countryside
Hickory Hills
Hinsdale
Hodgkins
Indian Head Park
Justice
La Grange
Lyons
McCook
Riverside
Summit
Western Springs
Willow Springs
What skills/resources are you bringing into the coalition?
Your answer
Are you involved in any other community-based organizations and efforts?
Your answer
Do you have any other comments?
Your answer
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