Request edit access
Please complete the following to register to become a member of the Coalition for Community Living (CCL).
Membership fees are as follows:
$55 for an individual or professional
$110 for an organization (includes one lodge; an additional $10/extra lodge)
$15 for a student
All membership fees should be paid to:
Steve Plyler (Treasurer)
Human Services Center
130 W. North Street
New Castle, PA 16101
Please note membership will not be approved until payment is received.
Name (first and last)
Type of membership desired
Never submit passwords through Google Forms.
This form was created inside of Threshold Rehabilitation Services, Inc..
Terms of Service