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?
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Individual - $20 cash/check; $21 online credit card
Organization/Business - $70 cash/check; $73 online credit card
Main Contact - Full Name
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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
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Street Address
Street Address Line 2
City
State / 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
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Delegate #1 Email
*
Delegate #2 Full Name
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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)
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Main Contact
Director
Delegate #1
Delegate #2
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?
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By Cash/Check
By Credit Card Online/Paypal
If by Cash/Check, please list the name of the payee?
ie. Jane Smith, Janesville Borough, Org for Happy Trees
Memberships
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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
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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