Foundations Foundation/Philanthropic/Credit Union/United Ways Membership Form Date* Date Format: MM slash DD slash YYYY Organization*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Federal Tax ID#(if applicable) Website Organization Phone #*Contact Person* First Last Title*Email* Enter Email Confirm Email Direct Phone #*Billing Address(if different from above address) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many employees does your department/organization have?*How many board members does your organization have?*How many board seats are still unfilled?*Staff Contact InformationIf you would like staff members to be listed please include Name, Title, and Email AddressAnnual Membership Investment*From line 12 of 990 Formx < $1,000,000 - $150.00$1M - $10M - $275.00$10M - $50M - $500.00$50M - $100M - $650.00> $100M - $850.00Discount Code Total $0.00 Credit Card* Card Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.