You can help support the Lake County
Center for Independent Living (LCCIL) by becoming a member. LCCIL
is a nonprofit, non-residential, cross-disabilities organization that
offers programs and advocacy that promote a fully accessible society.
Name:
Address:
City:
State:
Zip:
Yes, I want to become a member:
$ 5.00 Mentor Level
(or 5 hours of volunteer service to LCCIL)
$15.00 Leader Level
(or 15 hours of volunteer service to LCCIL)
Yes, I would like the
LCCIL Vote Every Election pin
$30.00 Advocate Level
Yes, I would like the
LCCIL Vote Every Election pin
Yes, I would like the
LCCIL Vote Every Election tote bag
Yes, I would like to make a donation:
$5.00
$15.00
$25.00
$50.00
$100.00
Other amount $
Yes, I would like to volunteer:
At the Center
Gala Benefit Committee
Special Events
Please fill in, print out form and mail with check/money
order payable to:
Lake County Center for Independent
Living
377 N. Seymour Avenue, Mundelein, IL 60060
Thank you for your support!
Membership fees and donations are tax
deductible to the extent allowed by law.
FOR OFFICE USE ONLY
Check
Money Order
Total Received $________
Check # ________
