Membership Commitment Form

Your Name (required)

Additional Names

Your Email Address (required)

Additional Email Addresses

Home Phone

Cell Phone (required)

Street Address (required)

City, State, Zip (required)

Membership Amount (required) $

Today's Date (required)

Additional contribution to support strategic planning initiatives

My payment preference for joining* Pay in fullTwo installments; first due upon joining, last due by July

Signature (required)

* Our calendar year is July to June. Annual renewals begin in July. Your check may be prorated based on the month you join. Please contact Renee (312-402-8339) or Leslie (847-207-2266) to determine the amount to send in for your first year.

Please complete this form, print, sign, and mail it along with your payment to:
B’Chavana, PO Box 7608, Buffalo Grove, IL 60089.

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