2003 PALM Membership Application

Membership dues for PALM are collected annually for the calendar year, and are based on $1.80 per capita of your organization within the Tri-county area of Peoria. For example, a company of 100 employees would pay $180 per year to be a member of PALM. The minimum rate is $90 per year. Dues will be prorated for new members joining during the year. For unions the same formula would apply, with a $300 maximum.

However, if you are a government entity or a not-for-profit organization your yearly membership dues would be $450 per year, or $90 per year if you have under 50 employees.

Associate membership is $450 per year, for all other groups. For Associate members with fewer than 50 employees, the membership is $90 per year.

To join, please print and mail the form below with your company's payment. For more information call (309) 495-5990.

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Organization ______________________________________________________

Contact person & title________________________________________________

E-mail: ___________________________________________________________
(this is required for communication because we do not send out postal mailings)

Street Address______________________________________________________

City/State/Zip Code _________________________________________________

Telephone _________________________________________________________

Membership Dues Calculation:
Private sector: ________ employees x $1.80 = $ ________($90 minimum)

Unions: _________ members x $1.80 = $ _________ ($90 min./$300 max.)

Government & Not-For-Profit Organizations: ________
(under 50 employees - $90; 50 employees or more - $450)

Associate Members: ___________
(under 50 employees - $90; 51 employees or more - $450 maximum)

Please make check payable to PALM/LMC Health Programs and mail to:
PALM/LMC Health Programs
124 S.W. Adams, Suite 310
Peoria, IL 61602