IL Mano a Mano Membership Form
Please fill out date completely and provide any other documentation required. Once the form and payment are received and processed, a confirmation email will be sent to the email noted below and with a printable membership card.

Membership expires every year on December 31st.

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Contact Information
Full Name: *
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Date of Birth: *
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Mailing Address: *
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City, State, Zip Code *
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Email: *
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Membership Type (Please select one): *
Extra Donation:
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Enter total amount from above: *
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Any questions/concerns, email: secretary@illmano.org
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