About Us
Leadership
Committees
Who we are
Contact Us
advocacy
Legislative Priorities
Achievements
Take Action
Membership
Become a Member
Membership Directory
Resources
Information and Resources
Definitions
Members Only Resources
News
latest news
Newsletter
events
Calendar of Events Page
Membership Meetings
Webinars
TRIAL MEMBERSHIP APPLICATION
Name of County/Township Board or Association:
Address
City
State
Zip
Telephone:
FAX:
Key Contact
Position:
E-Mail:
Check All that Apply
708 Board
553 Board
377 Board
Group initiating referendum
Mental Health Committee
Total Budget for current fiscal year *
$
* Include here your TOTAL from all sources of funds including monies generated from non-levy sources (federal dollars, etc.).
TOTAL derived from tax levy, interest income and personal property replacement tax (if any)
$
Fiscal Year:
Begins
Ends
Levy Rate **
** Include here the actual tax rate at which your board is levying during the current fiscal year.
BOARD MEMBERS
Name
Address
Occupation
Select
Member 1
Member 2
STAFF
Name
Position/Title
Select
Abc
Pqr
AGENCIES OR PROGRAMS FUNDED*
NAME of Agency or Program
MI
DD
SUD
OTHER
Mark
@mdo
@mdo
@mdo
@mdo
X
To access this page please
Register
or
Login
