JOIN

YES, I agree to join CHANGE Illinois. I support campaign contribution limits and the CHANGE Illinois "Statement of Principles".

*If you choose to be listed as an individual and your employer is not a member of CHANGE Illinois, our list of coalition members will place an asterisk next to your name indicating "THE AFFILIATION APPEARS FOR IDENTIFICATION PURPOSES ONLY."

Questions? Please call Cindi Canary at (312)335-1767 or Jim Bray at (217)793-8416.

You can also print out this form and mail or fax it in.

Full Name: *

Phone: *

Fax: *

Email: *

City: *

Street: *

Zip: *

Option A (If membership should be listed as a corporation, association or organization, please complete the following): Name of business, union, association or organization

Option B (If you are to be listed as an individual, please complete the following): Name and Job title (or retired) and Employer