Every Child Matters-LI Supporting Member Application

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To become a Supporting Member, you must 1) complete this membership application and 2) make a $25 tax-deductible donation to Every Child Matters-LI (online, by mail or phone). Memberships are valid for 1-year.

First Name

Last Name

Date

Address, City, State and Zip Code

Home Telephone

Work Telephone

Mobile Telephone

Email Address

Have you been a "Supporting Member" of ECM-LI in the past?

YES

Name of Employer

Nature of Business

Title or Position

Would you like to be a 15 Minute Advocate and receive e-news and action alerts?

YES

Would you like to participate in a community cluster in your town?

YES

Would you like more information about an ECM presentation?

YES

How did you hear about Every Child Matters-LI?

How will you make your $25 donation?

Online via www.everychildmattersli.org

By check made out to Every Child Matters-LI (mailed to 1740 Old Jericho Tpke., Jericho NY 11753)

By phone (631) 885-8044 using a credit card.

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