LINC INC.

Membership Form

Fill out all information requested and then print this page and mail the form along with your check in the amount of the membership level you chose. If you would prefer to pay with a credit or debit card please use the GiveDirect option found at the bottom each web page.

LINC, Inc.
Attn: Anita Overturf
120 East A Street
Belleville, IL 62220

Name LINC Heros

Address

City State    Zip

Home Phone Work Phone

Email Address

Membership Level (Check Appropriate Box)

$10 Individual Membership (Consumers & Volunteers)
$20 Individual Membership
 $35 Family/Not-For Profit Organization

$50 Business Membership
$100 Investor Membership

Donations above membership amounts are always appreciated.  Amount:_______________

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