Coalition Membership Form

Thank you for your interest in becoming a CHARACTER COUNTS! member. As a member, you agree to integrate character education into your programs and, specifically, to promote the Six Pillars of Character: trustworthiness, respect, responsibility, fairness, caring and citizenship.

Step 1 of 2

Organization Information
Organization Name*
Organization Type*
School Type (Optional)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Organization Phone*
Organization Fax Number
Number of Site Locations*
Website

If you choose not to enter your website address here or simply do not have one – it will not show up on the membership directory on our website.

Primary Contact Information
Name*
First Last
Title*
Email*
Enter Email Confirm Email
Phone*
School or Single Youth Site*
Non-School Organization*
Multi-Site Sites Non-School Org*
School District/Regional Membership Level*
National Membership Level*
Total
$0.00
Payment Method*
- Credit Card
- Purchase Order
- Check (via mail)
Purchase Order #*
Optional PO Upload
Accepted file types: jpg, jpeg, tiff, pdf, doc, docx, Max. file size: 63 MB.
Credit Card*

Discover
MasterCard
Visa
Supported Credit Cards: Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Key Benefits:

10% discount on most products available for purchase in our online store*
Discounted rates on Student Development Workshops (SDW) for all of your members
$200 discount on in-service workshops at your facility

Questions?
Email or call: 515-271-1910

*Membership discounts may not be combined with other offers, coupons or discounts and is excluded on select items.

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Coalition Membership Form

Step 1 of 2

Organization Information

Primary Contact Information

Key Benefits:

Questions? Email or call: 515-271-1910

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Questions?
Email or call: 515-271-1910