Membership Application
Please complete the following to register to become a member of the Coalition for Community Living (CCL).  
Membership fees are as follows:
$55 for an individual or professional
$110 for an organization (includes one lodge;  an additional $10/extra lodge)
$15 for a student
All membership fees should be paid to:
Tim DeTal (Treasurer)
Human Services Center
130 W. North Street
New Castle, PA  16101
Please note membership will not be approved until payment is received.
Sign in to Google to save your progress. Learn more
Email *
Type of membership desired *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy