Subscriber Registration and Renewal Form 

Directions:

Please complete the fields below and submit as directed. 

Section 1 is for your agency to renew subscription and identify the person to receive the invoice to follow.  Do not submit payment with the return of this form as CLINIC will submit an invoice for $1,500 to your designated accounts payable person indicated below.

Section 2 asks for your agency’s agreement in upholding CLINIC’s Core Standards for Charitable Immigration Programs and the Terms and Conditions contained within the Subscription Agreement.  Please check your agreement with both documents.

Section 3 is a link and reminder to complete the 2012 CLINIC Affiliate Survey.  Your program and staff information will be shared with CLINIC as the most up to date contact record available. 

Section 4 asks for the name and contact information of the person authorized to renew CLINIC Subscription.

Thank you and we look forward to continuing to be of service to you and your colleagues in 2013.