Indiana Coalition for Human Services Membership Form

Thank you for your interest in becoming a member of ICHS – Indiana’s leading human services advocacy group. We engage, educate, and mobilize on fact-based, equitable public policies resulting in quality human service outcomes for ALL Hoosiers.

Membership Level and Annual Subscription Rates

We offer two different levels of membership for organizations. Please see the descriptions below and choose what level fits your budget.

FULL MEMBERSHIP – Dues are based on organization’s annual budget (see below) – includes access to “members only” services, voting privileges toward governance and policy priority setting, organization profile on ICHS website, and lowered event fees. Committee participation is strongly encouraged.

Organization’s Annual Budget	ICHS Annual Dues
Under $25,000	$250
$25-$150,000	$350
$150,001-$500,000	$500
$500,001-$1,000,000	$750
$1 million and above	$1,000

ASSOCIATE MEMBERSHIP – $200 – Ideal for members of Full Members and mission-aligned organizations that seek to be involved, but without all the benefits of full membership. Benefits include your organization’s name on ICHS web site, lowered event fees, online grassroots advocacy, newsletters & email action alerts, and voluntary participation on ICHS Committees.

Email(Required)

Organizational Membership Level(Required)

Yes, I would like to be a FULL member

Yes, I would like to be an ASSOCIATE member

Please Indicate Amount to be Invoiced(Required)

Name of Organization(Required)

Mailing Address (including zip code)(Required)

Website

Phone(Required)

Primary Representative's Name(Required)

First Last

Primary Representative's Title(Required)

Primary Representative's E-mail(Required)

Primary Representative's Phone Number(Required)

Alternative Representative's Name

First Last

Alternative Representative's Title

Alternative Representative's E-mail

Alternative Representative's Phone Number

Would you like to serve on a committee?

Education

Membership

Governmental Affairs