Leadership Council New Nonprofit Member Application

Contact Information:

• * Organization Name:
• * Primary Contact for Membership Communications:
• * 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:
• * Your membership investment is based on annual revenue. IN THE FIELD BELOW, PLEASE ENTER YOUR ANNUAL REVENUE from your most recent IRS Form 990 (line 12) or 990EZ. Please enter numbers only, not letters or punctuation. Note: Dues for NEW members are 50% for the first year. The fee schedule below reflects 50% of normal dues. (Previous members with a gap in membership are not eligible for the discounted rate).

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Annual Revenue: Up to $250,000...	$95.00
  Annual Revenue: $250,001 - $500,000...	$120.00
  Annual Revenue: $500,001 - $2,000,000...	$160.00
  Annual Revenue: $2,000,001 - $5,000,000...	$275.00
  Annual Revenue: $5,000,001 - $10,000,000	$350.00
  Annual Revenue: $10,000,001 - $20,000,000	$425.00
  Annual Revenue: $20,000,001 and above	$500.00

• * Years in Position?
• * Years in Nonprofit Work?

Information below is for statistical purposes only:

• *

  Type of Organization (choose 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
• * Enter the organization's EIN number:
• * Please provide the number of part-time employees (please enter numbers only, not letters or punctuation):
• * Please provide the number of full-time employees (please enter numbers only, not letters or punctuation):
• * Please enter your mission statement below:
   characters remaining
• * How did you learn about Leadership Council?

• Leadership Council features a member directory on our website with your mission, website, and logo. Please send your logo to administration@leadershipcouncil.us. Thank you!

Other Staff Who Should Receive Leadership Council communications:

• Name 1
• Position
• Email
• Name 2
• Position
• Email
• Name 3
• Position
• Email