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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