Human Services Council 2006-2007 Membership Application

An association of over 60 public and
private not-for profit organizations
and individual community members seeking
to develop and improve human services

2008-2009 Membership Application

Thank you for your interest in the Human Services Council of Champaign County. Please fill out the membership application form below and return it with your check. You or your organization will then be added to the 2008-2009 membership list. Make checks payable to Human Services Council.

Membership Annual Fees Due June 1

____ Agency Membership $25 ____ Individual/Non-agency Membership $10

Membership Name _________________________________________________
Address________________________________________
State/Zip ______________________________________
Phone ______________________________________
E-mail ________________________________________
Agency Representative(s) _________________________

If you would like a link to your agency web site from the HSC site, please clearly print your web site address here:
________________________________________________

Please provide a brief descriptive sentence about your organization (about 10 words or so) to add alongside your web site link.
__________________________________________________________________________________________

We welcome and need active HSC committee participation! Please put a check by the committees you would like to participate on (you may choose more than one):
____ Anti-Racism / Diversity Committee
____ Audit / Budget Committee
____ Forum Committee
____ Legislative Committee
____ Media Committee

To join HSC-ANNOUNCE, a low-volume e-mail list designed to distribute announcements and minutes to members of the Human Services Council of Champaign County, go to the HSC web site at www.hsccc.org and click on the link "Subscribe to HSC-Announce".

Send this membership form and payment to:

Human Services Council
P.O. Box 2072, Station A
Champaign, IL 61825