New Member Interest Form

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New Member Interest Form

Member Info

Member Name(Required)

First Last

Member Date of Birth(Required)

Member Address(Required)

City State / Province / Region

CEL Programs primarily take place at our building in Riverwoods, Illinois and the surrounding community. Please take this in consideration when seeking services.

Primary Contact Information

Is the member the primary contact?(Required)

Yes

No

Primary Contact(Required)

First Last

Primary Contact Email(Required)

Primary Contact Phone(Required)

Program Interest

Which programs are you interested in?(Required)

Teen/Young Adult (13-22) Programming

Adult (18+) Day Programming

Adult (18+) Social/Recreation Programming

Employment Services

Mental Health Services

Is there anything you'd like us to know about your interests or needs?(Required)

You belong at CEL!

Programs are centered on YOU! Choose from a wide range of social, recreational, and educational enrichment programs available seven days a week. Check out our program guide and learn how to get started today!

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Enrich lives today!

Your donation will transform and enrich the lives of our members with intellectual and developmental disabilities.

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