Membership Application2007 membership dues good through Dec. 31.
For members joining after March 31, membership dues will be pro-rated on a quarterly
basis for the first year of membership
|
Primary Contact (voting delegate):
|
|
|
Last Name: |
|
|
Title:
|
|
|
E-mail:
|
|
|
Phone:
|
|
|
Organization:
|
* for an individual members, please enter lastname, firstname
for the organization name.
|
|
Secondary Contact:
|
|
|
Title:
|
|
|
E-mail:
|
|
|
Phone:
|
|
|
Address:
|
|
|
Address:
|
|
|
City:
|
|
|
State:
|
|
|
Zip:
|
|
|
County: |
|
|
Fax:
|
|
|
Website: |
|
|
|
|
|
Founded: |
|
|
Mission: |
|
|
|
|
|
Annual Operating Budget: |
|
|
#Full-time Employees |
|
|
#Part-time Employees |
|
|
# of Volunteers |
|
|
Nonprofit Service Category: |
Other:
|
|
|
|
|
Regular Nonprofit Member
|
Choose one membership category
|
| |
Annual operating budget
|
DUES
|
|
A.
|
Less than $50,000
|
$60
|
|
|
B.
|
$50,000 – 149,000
|
$100
|
|
|
C.
|
$150,000 – 449,000
|
$175
|
|
|
D.
|
$500,000 – 999,999
|
$250
|
|
|
E.
|
$1,000,000 – 1,999,999
|
$300
|
|
|
F.
|
Greater than $2,000,000
|
$400
|
|
|
Sustaining Member
|
|
G.
|
Grant making organization (amount of dues over $400 can be counted as a
qualifying distribution)
|
$1,000
|
|
|
Associate Member
|
|
H.
|
Business, consultant, government agency
Special Rate for 2007
|
$35
|
|
|
Individual Member
|
|
I.
|
Board member, volunteer, student
|
$35
|
|
|
Emerging Organization
|
|
J.
|
New organization (less than two years old), or may be in the process
of forming a nonprofit organization
|
$25
|
|
|
|
|
TOTAL: $
0 |
|
|
|
|
|
|
|
