2022 Membership Renewal

Primary Contact for Membership:

• * Organization Name:
• * Primary Contact for Membership Renewal:
• * Job Title:
• * Email Address:
• * Phone:

CEO, President or Executive Director:

• * First Name:
• * Last Name:
• * Job Title:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * Website:
• * Membership Dues are determined by your Annual Revenue. Please enter your Annual Revenue from most recent IRS Form 990 (line 12) or 990EZ.

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Annual Revenue: $5,000,001 +...	$640.00
  Annual Revenue: $2,000,001 - $5,000,000...	$500.00
  Annual Revenue: $500,001 - $2,000,000...	$300.00
  Annual Revenue: $250,001 - $500,000...	$220.00
  Annual Revenue: Up to $250,000...	$180.00

• * Years in Position?
• * Years in Non Profit?

Information below is for statistical purposes only:

• *

  Type of Organization (check all that apply):

  • Advocacy (case/client)
  • Aging
  • Alcohol & Drug Treatment
  • Animal-related
  • Arts & Culture
  • Children & Youth
  • Community Development
  • Criminal Justice & Legal
  • Disabilities
  • Domestic Violence
  • Early Childhood
  • Economic Development
  • Education
  • Employment
  • Environmental
  • Health
  • HIV/Aids
  • Housing
  • Human Services
  • Literacy
  • Medical Research
  • Mental Health & Crisis Intervention
  • Philanthropic
  • Public Safety
  • Religious
  • Social Justice
  • Other
• * Please provide the number of full-time employees:
• * Please provide the number of part-time employees:

Other Staff Who Should Receive Leadership Council communications:

• Name
• Position
• Email
• Name
• Position
• Email
• Name
• Position
• Email