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NPower NY Membership Form

Thank you for your interest in joining NPower NY! Please complete the membership application below. Questions? Call 212-564-7010 or contact us online.

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Organization

Name
Main Address 1
Main Address 2
City  State  Zip 
Main Phone example: (999) 999-9999 ext 999
Main Fax example: (999) 999-9999
Website Address
Employer Tax ID Number (Nonprofit organizations only)

Executive Director

(Nonprofit Memberships only)
Name examples: Mr. John Smith Jr.; Dr. Jane Brown
  Check if the address is the same as organization's
Address 1
Address 2
City  State  Zip 
Telephone example: (999) 999-9999 ext 999
Fax example: (999) 999-9999
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Technical Contact

(Nonprofit Memberships Only)
Name examples: Mr. John Smith Jr.; Dr. Jane Brown
Title
  Check if the address is the same as organization's
Address 1
Address 2
City  State  Zip 
Telephone example: (999) 999-9999 ext 999
Fax example: (999) 999-9999
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Membership Contact

Name examples: Mr. John Smith Jr.; Dr. Jane Brown
Title
  Check if the address is the same as organization's
Address 1
Address 2
City  State  Zip 
Telephone example: (999) 999-9999 ext 999
Fax example: (999) 999-9999
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Membership Type

$100/year, Nonprofit Organization
$300/year, For-Profit Organization
If you selected Nonprofit Organization membership, please provide the following information:

Describe your organization's mission in one or two sentences.

Organization's Sector

  • Arts and Culture
  • Civic/Community Development
  • Education
  • Environment
  • Housing/Homelessness
  • Health and Human Services
  • Legal/Advocacy
  • Youth Services
  • Other: please describe

Annual Operating Budget

  • Annual Operating Budget Less Than $50,000
  • Annual Operating Budget of $50,001-$100,000
  • Annual Operating Budget of $100,001-$250,000
  • Annual Operating Budget of $250,001-$500,000
  • Annual Operating Budget of $500,001-$1,000,000
  • Annual Operating Budget of $1,000,001-$5,000,000
  • Annual Operating Budget of $5,000,001-$10,000,000
  • Annual Operating Budget of more than $10,000,001

Membership Discount

If your organization is taking advantage of a membership discount offer, enter the discount code and the amount of the discount below:

Payment Information

I am mailing a check made out to NPower NY in the amount of
 

Membership dues should be mailed to:

  • NPower NY/Membership
  • 145 West 30th Street, 8th Floor
  • New York, NY 10001
I prefer to pay by VISA or MasterCard. Please contact me for more information.
I prefer to be invoiced. Please send the invoice to my attention.
My organization's dues will be paid by the following third party:
 

Publicity Permission

NPower NY has permission to include my organization in public lists of its members.
NPower NY does not have permission to include my organization in public lists of its members.

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