Please fill in the form below.

If you prefer to fax in your application, this form and fax it to (715)693-8738
If you have any question please call the Cornerstone office at (847) 756-7600



Sponsor's Information
Team leader’s Name
Sponsor’s Name ID NUMBER


New Member Details
First Name
Last Name
Email Address
Re-enter Email address
Phone (hm)
Phone (cell)
ItWorks ID number
ItWorks password
Address
Street Address
City
State/Province
Zip/Postal Code
Country