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Nonprofit Membership Form
Nonprofit Organization
*REQUIRED*
Tax Exempt Number
First Name
*REQUIRED*
Primary Organizational Contact
Last Name
*REQUIRED*
Mailing Address
*REQUIRED*
City
*REQUIRED*
State
*REQUIRED*
Zip Code
*REQUIRED*
Phone
*REQUIRED*
Fax
Email
*REQUIRED*
Website
Name/email/title of additional staff/volunteers to receive electronic information from NDANO
Mission/Core Function
Membership Dues
*REQUIRED*
Operating Budget = Dues
Select one
$0-75,000 = $50
$75,001-150,000 = $100
$150,001-250,000 = $150
$250,001-500,000 = $250
$500,001-1M = $375
$1,000,001-2.5M = $425
$2,500,001-5M = $500
Over $5M = $600