Funding Information Center

Membership Application Form

Reminder! Please complete this application and make sure it
is accompanied by your check for membership or payment online. Thank you!

 Date:   (mm/dd/yy)

 

Yes, we would like to renew our membership with the FIC at the level of:

     Nonprofit Organizations with Annual Budgets above $5,000,000                                   ($500/year)

      Nonprofit Organizations with Annual Budgets between $250,000  & $5,000,000          ($330/year)

      Individuals & Organizations with Annual Budget below $250,000                                 ($110/year)

    

Membership Information:

Organization Name:  Web Site: 2011 Operating Budget:
Address:  City: State:  Zip Code:     
Phone:  Fax:  Number of Employees:   United Way Agency?
Executive Director:  E-mail:  

Contact Person:

 

1.  Name:       Title:     E-mail:

 

PLEASE LIST ADDITIONAL CONTACTS BELOW:

 

2.  Name:       Title:     E-mail:

3.  Name:       Title:     E-mail:

4.  Name:       Title:     E-mail:

5.  Name:       Title:     E-mail:

6.  Name:       Title:     E-mail:

 

HR contact for Job Positions:      Title:     E-mail: 

 

Board of Directors Contact:      Title:     E-mail:

 

Please check your agency category: 

 

Funding Information Center ∙ 2701 W. Berry, Ste. 128 Fort Worth, TX 76109

∙ (817)334-0228 ∙ www.fic-ftw.org

Remember! Please complete this application and make sure it
 is accompanied by your check for membership or payment online!

Have questions? Need help filling out this application? Email Linda McMillan or call us 817-334-0228