BCCN Membership Dues Online Payment Form

Membership Dues Online Payment Form

FY 2023
Organization Name*
Please list your organization's name as you would like it to appear in BCCN publications.
Your Name*

First NameLast Name
Job Title*
Please list your title with the organization.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Would you like your receipt....*

MailedEmailed
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MEMBERSHIP DUES

Different levels of dues are offered to give members options for participation in the BCCN and to encourage the participation of more community members. Dues are payable on or before October 1 each year. Please choose the appropriate membership level below to make your payment online.
Membership Level
prevnext( X )
Voting MemberState-required collaborative member organizations pay dues at the $500 level. At this level, the appointed alternate may vote in the absence of the chief administrator. Up to five additional organizational members can attend meetings as non-voting members.These members include the Branch Intermediate School District, Community Action, ProMedica Coldwater Regional Hospital, Community Mental Health (Pines Behavioral Health), Community Health Agency, County of Branch (County Administrator or his/her designee), and the Department of Human Services.
$500.00



AlternateNon-governmental organizations members may appoint one alternate who represents the organization and can vote in the absence of the chief administrator. Up to two organizational representatives may attend BCCN meetings each month.
$200.00



Non-Voting MemberOne representative from an organization attends monthly meetings. Members at this level do not vote on BCCN issues
$50.00



Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Membership Dues Online Payment Form

MEMBERSHIP DUES