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Nonprofit Association Of The Midlands Membership Application

Annual Budget	Annual Membership Dues
Under $49,999	$150
$50,000 to $499,999	$250
$500,000 to $999,999	$350
Over $1,000,000	$500

Membership has is benefits, click here to find out more
* denotes required field
Referred by:
* Organization Name:
* Federal ID# (EIN):
* Contact First Name:
* Contact Last Name:
* Title:
* Address:
Address2:
* City:
* State:	-- select -- 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
* Zip:
* Phone:
Fax:
* Email Address:
Web Site:
* Annual Budget:	-- select -- ($0 - $49,999) Annual Dues: $150 ($50,000 - $499,999) Annual Dues: $250 ($500000 - $999,999) Annual Dues: $350 ($1 million or more) Annual Dues: $500
* Employees:	Full-Time Part-Time
* Type of Organization:	-- select -- Arts/Culture/Humanities Civic/Municipal Education Environment/Animals Health Human Service International/Foreign Neighborhood Philanthropy Religious Scholarships Youth Other
Mission: limited to 200 characters
Description: limited to 500 characters
* Endowment Does your Non-profit organization have an endowment?	YesNo