Application

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Organization Information (to be displayed online)

Organization Name

Address 1

Address 2

City

State

Zip

County

Phone

Website

Main Contact

Copy from Organization-Information

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Additional Contacts

Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

Add/Remove Contacts

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Additional Information

Referred By

How did you hear about us?

What is your reason for joining?

Please have someone contact me regarding

Business Resources
Community Involvement
Cost Savings Programs
Economic Development
Government Relations
Networking
Training Opportunities
Other

Membership Dues Based on your Annual Total Expenses

Membership Type

Annual Membership Expense Budget (found on 990*)

*Line 18 on the 990 tax form. If your Annual Total Gross Receipts are below $50,000, you would have submitted a Postcard in lieu of the 990 form.

Number of Full Time Employees

Primary Directory Category

Additional Directory Categories

Select additional directory categories below by holding the "CTRL" key
Secondary categories may be subject to additional fees

Grantstation & Society for Nonprofit Organizations Subscription ($30)

Annual Membership Investment

Additional Items

Additional Categories Cost

Tax

Total

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Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets Cost

Millions in Assets

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Grantstation & Society for Nonprofit Organizations Subscription

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Additional Item 2

Additional Item 3

Additional Item 4

Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Number of Rooms

Number of Seats

Number of Associates

Number of Locations

One-Time Application Fee

Number of Part Time Employees

Credit Card Information

Copy from Organization Information

Credit Card Type MastercardVisaDiscover

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

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