Membership Dues/Application

Bloomingdale CHARACTER COUNTS! Coalition
201 S. Bloomingdale Road
Bloomingdale, IL  60108

Individual membership:  $10.00
Family membership:      $25.00
Governmental agency membership: 
    Less than $1 million budget: $  50.00
    $1 - $10 million budget:         $100.00
    Over $10 million budget:        $200.00
Business membership:
    1 – 10 employees:      $  50.00
    11 – 50 employees:    $100.00
    51 – 100 employees:  $150.00
    Over 100 employees:  $200.00

To apply for membership, print this page/form, circle the type of membership you desire (above), fill out your name and address (below), and mail this form and your check to:

Bloomingdale CHARACTER COUNTS! Coalition
ATTN:  Treasurer
c/o  Barbara Weber, Asst Village Administrator
Village of Bloomingdale
201 S. Bloomingdale Rd.
Bloomingdale, IL  60108


Your name:___________________________________________

Your organization (if applicable):___________________________

Address:____________________________________________

              ____________________________________________

Questions?  Call Barb at tel:  630 671-5613.  Thank you!!