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 50% Organization InformationOrganization Name*Organization Type*School or Single Youth SiteNon-School OrganizationMultiple Sites Non-School OrgSchool District or Regional OrganizationNational OrganizationSchool Type (Optional)Adult EducationElementaryHigh SchoolK-5K-8K-12Middle SchoolAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Organization Phone*Organization Fax NumberNumber of Site Locations*Single SiteMultiple SitesWebsite 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 InformationName* First Last Title*Email* Enter Email Confirm Email Phone*School or Single Youth Site*Basic (1-year)Standard (2-years)Premium (3-years)Non-School Organization*Basic (1-year)Standard (2-years)Premium (3-years)Multi-Site Sites Non-School Org*Basic (1-year)Standard (2-years)Premium (3-years)School District/Regional Membership Level*Basic (1-year)Standard (2-years)Premium (3-years)National Membership Level*Basic (1-year)Standard (2-years)Premium (3-years)Total $0.00 Payment Method*Credit CardPurchase OrderCheck (via mail)Purchase Order #*Optional PO UploadAccepted file types: jpg, jpeg, tiff, pdf, doc, docx.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Marketing Communications* Yes. Please include me in your weekly newsletter mailing list. No. I do not wish to receive marketing emails. CAPTCHANameThis 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.