Organization Membership Application
Name of Organization or Business:
Street Address, City, State, Zip:
Contact person:
Phone Number:
Email Address:
Please tell us about your organization. This is helpful information to have when we are
evaluating appropriate matches or exchanges. Please add a page if you need more room.
Please list three services you would most like to provide to our members. You can refer
to the list on the back of this page or add your own.
Please list three services you would most like to receive from our members. You can refer
to the list on the back of this page or add your own.
Please name the people in your organization who are authorized to report Chippewa Valley Timebank exchanges.
Please sign off on the following statement:
I understand that, as a Chippewa Valley Timebank member, we offer neighborly services to
each other. Members provide service to the best of their ability and do not guarantee their work.
Signed:
Date:
Terms and Conditions for
Organizational Members of Chippewa Valley Timebank
Non-discrimination policy
Registering organizations and companies agree to not use Chippewa Valley Timebank members for
activities or programs that discriminate according to gender, sexual orientation, socio-economic status,
ability, race, age, political or religious affiliation. Organizations whose policies, procedures or practices
include discrimination against any of the previously listed groups are not eligible for membership in the
Chippewa Valley Timebank. Political parties are not eligible for membership in Chippewa Valley Timebank.
Nature of work done at organizations and companies
Organization or company agrees to not eliminate paid positions for the specific purpose of making
positions available for Chippewa Valley Timebank members.
Debit/Credit limits
Organizational members of Chippewa Valley Timebank are expected to both spend and earn time credits.
If an organization has a debit of 500 or more credits, the coordinator will be in contact to discuss options
for earning or spending.
Fee structure
We ask each organization member to contribute $25 per year, (more if budget allows, less if budget
dictates) toward the coordination and maintenance of Chippewa Valley Timebank. Organizations unable
to pay this fee are encouraged to contact Chippewa Valley Timebank staff to discuss other ways we might
create value together. No organization will be turned away due to inability to pay.
Signature of the Organization/Company Representative
Date
Please read and sign (electronic signature) the Membership Agreement on the next page. A detailed copy
of the Member Handbook is available for viewing on our website at www.chippewavalleytimebank.org.
Membership Agreement
I understand that the Chippewa Valley Timebank does background checks on all new members and
that the references, employers and volunteer organizations I have provided on my application may
be contacted.
(For organizations only.) I agree that any exchanges I arrange for my organization will involve only
people that have had a background check, either by Chippewa Valley Timebank or by my
organization.
I understand that, the Chippewa Valley Timebank offers neighborly services and members provide
services to the best of their ability and do not guarantee their work.
I understand that the Chippewa Valley Timebank is a coordinating agency only and cannot guarantee
the performance of anyone who is referred, and is not responsible for the services performed.
I understand that expenses for any materials used in providing services will be agreed upon before
the service is delivered.
I agree to only exchange lawful services through the Chippewa Valley Timebank.
I understand that the Chippewa Valley Timebank cannot be held responsible for any injury to
persons or damage to property experienced while involved with the program. I hereby agree to hold
the Chippewa Valley Timebank harmless from any and all claims or liabilities for any activities
performed by a Chippewa Valley Timebank member.
I understand that there will be immediate termination of membership of any member who harasses,
harms, or interferes with any other Chippewa Valley Timebank member.
I agree that if I use my personal vehicle in rendering volunteer service through the Chippewa Valley
Timebank, I will, in accordance with Wisconsin law, arrange to keep in effect legal automobile liability
insurance covering bodily injury and property damage.
I agree not to reveal any personal information provided by fellow time bank members. I will not
reveal the password for my time bank account to non-members, and will use reasonable care to
protect the password.
I have read the Member Handbook and agree to its terms.
I certify that the information provided to the Chippewa Valley Timebank is accurate.
Member Name (Print)
Member Signature
Date
PLEASE PRINT THE NEXT PAGE AND BRING TO YOUR INTRO TO CHIPPEWA VALLEY TIMEBANK SESSION. (THIS
WILL BE SCHEDULED BY A PHONE CALL FROM A VOLUNTEER WHEN YOUR APPLICATION HAS BEEN ACCEPTED.)
Chippewa Valley Timebank
Chippewa Valley Timebank
www.chippewavalleytimebank.org
info@chippewavalleytimebank.org