Organizational Membership

Name: Organizational Membership
Availability: InStock

From: $35.00 / year

Organization Annual Budget

Clear

Member Information
Name of Organization*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Street Address
- Same as Mailing Address
Street Address
Street Address Address Line 2 City State ZIP Code
Organization Website
Organization Phone*
Does your nonprofit have a Facebook page?*
- Yes
- No
Number of Full-Time Employees*
35+ hours per week
Number of Part-Time or Seasonal Employees*
Number of Volunteers*
Year Incorporated*
EIN
Please enter your organization's 9 digit Employer Identification Number
Is your organization exempt under 501(c)(3) of IRS Code?*
Your Mission*
500 characters max
Contact Information
Contact Name*
First Last
Contact Title*
Contact Email*
Is this the Executive Director / CEO?*
- Yes
- No
Executive Director / CEO Name*
First Last
Executive Director / CEO Title*
Executive Director / CEO Email*
Geographic Region Served
Region Served - Check all that apply*
- Pittsylvania County
- Danville City
- Caswell County
- Other
Region Served (Other)
Total
$0.00
Email
This field is for validation purposes and should be left unchanged.

SKU: N/A Category: Membership

Description

Please note, if you are an individual and not affiliated with an organization, you may join using our individual membership.

Also, you may print out and mail in a hard copy of this form along with payment. Click here to download the PDF.

Organization Annual Budget	N/A, $0-50K, $50,001-75K, $75,001-100K, $100,001-250K, $250,001-500K, $500,001+