Funding Information Center

2008 Membership Application

 

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

 

Today's date:  ____________________________

 

Yes, we would like an FIC membership at the level of:

    0 Nonprofit organizations with annual budgets above $250,000    ($300/year)

    0 Nonprofit organizations with annual budgets below $250,000    ($100/year)

    0 Individuals, Students, and Consultants                                       ($100/year)

      

Membership Information:

 

Organization Name:_____________________________________________________Web Site:__________________________ 2008 Operating Budget: ___________

     

Executive Director:__________________________________________________________  E-mail:______________________________________________

 

Address:_______________________________________________________________ City/State/Zip:___________________________________________

 

Phone:__________________________ Fax:________________________ No. of Employees__________ United Way Agency?  Yes    0   No   0

Contact Person

 

1.  Name:_________________________________________ Title: _______________________________ E-mail: _____________________________________

 

PLEASE LIST ADDITIONAL CARD HOLDERS FOR ORGANIZATION AND ASSOCIATE LEVELS BELOW:

 

2.  Name:_________________________________________ Title: _______________________________ E-mail:______________________________________

 

3.  Name:_________________________________________ Title: _______________________________ E-mail:______________________________________

 

4.  Name:_________________________________________ Title: _______________________________ E-mail:______________________________________

 

5.  Name:_________________________________________ Title: _______________________________ E-mail:______________________________________

 

HR contact for Job Positions:_________________________ Title:________________________________E-mail:______________________________________

 

Board of Directors Contact:___________________________ Title:_______________________________ E-mail:______________________________________

 

Please check your agency category: