Public sector membership application

Government entity

Government entity name*

Address*

IllinoisAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoryNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

Phone*

Example: 555-555-5555

Website

http://…

Population served*

as determined at most recent U.S. Census

Budget*

in millions

Home rule status*

• H
• N

Counties served*

All Illinois counties

AdamsAlexanderBondBooneBrownBureauCalhounCarrollCassChampaignChristianClarkClayClintonColesCookCrawfordCumberlandDe WittDeKalbDonoughDouglasDuPageEdgarEdwardsEffinghamFayetteFordFranklinFultonGallatinGreeneGrundyHamiltonHancockHardinHendersonHenryIroquoisJacksonJasperJeffersonJerseyJo DaviessJohnsonKaneKankakeeKendallKnoxLa SalleLakeLawrenceLeeLivingstonLoganMaconMacoupinMadisonMarionMarshallMasonMassacMcHenryMcLeanMenardMercerMonroeMontgomeryMorganMoultrieOglePeoriaPerryPiattPikePopePulaskiPutnamRandolphRichlandRock IslandSalineSangamonSchuylerScottShelbySt. ClairStarkStephensonTazewellUnionVermilionWabashWarrenWashingtonWayneWhiteWhitesideWillWilliamsonWinnebagoWoodford

Primary member

Full name*

Position

Your email*

This will be your username

Choose a password*

Must be 8 characters or more

Re-type password*

Are there additional members to be added?

• Yes
• No