CCCHS Membership Form

Membership Form - 2026

Centre County Council for Human Services (CCCHS) Membership Form should be completed once annually by interested parties. The membership cycle runs January through December for members to take advantage of all benefits.
Is this membership for an individual or an organization/business?
Main Contact - Full Name
Main Contact - Email
example@example.com
Organization/Business Name
Director - Full Name
Director - Email
example@example.com
Organization/Business Website
Individual or Organization/Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Delegates

Each member agency may select up to two delegates to represent them at the November annual meeting and vote on CCCHS business. All staff, board members, and volunteers of a member organization are welcome to attend CCCHS member luncheons at any time.
Delegate #1 Full Name
Delegate #1 Email
Delegate #2 Full Name
Delegate #2 Email
Renewal notices will be sent out in the Fall of each year. Who should be notified about membership renewal? (Choose up to two)
Payment

Membership will be completed after you hit the submit button and either pay by cash/check or online by credit card. Please make check payable to "Centre County Council of Human Services." Checks may be mailed to P.O Box 1064, State College, PA 16804-1064.
How will membership be paid?
If by Cash/Check, please list the name of the payee?
ie. Jane Smith, Janesville Borough, Org for Happy Trees
Memberships
prevnext( X )
Individual Membership
Membership for one individual for one year.

$21.00

Organization/Business Membership
One membership for an organization/business for one year.

$73.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Membership Form - 2026

Delegates

Payment

Memberships*

Payment Methods

Memberships