MEMBERSHIP ENROLLMENT

Fiscal Year (January 1, 2008 - December 31, 2008)

Contact Susan Weiss ~ Treasurer if you have any questions: (217) 344-5024 TTY or susan@pacecil.org
Name:
Organization / Agency:
Address:
City, State, Zip Code:
Job Title:
Phone: Home / Work
Fax:
Email:                                                                                       Pager:

MEMBERSHIP CATEGORIES

£ Organization          £ Agency          £ Individual

$20 a year OR $5.00 per meeting/visit
 
Make check payable to: DSSP
Please print this membership form and send it with your check to:
Susan Weiss, Treasurer
PACE Inc.
1317 E. Florida Avenue.
Urbana, IL 61801