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Fax: (202) 207-0341
TTY: (202) 207-0340
Toll Free: (877) 525-3400
  
 
National Council
on Independent Living
 
 
Not Just Responding To
Change, But Leading It!
 

Organization Membership Application

Memberships are renewable annually and payment is due by January 31. Dues must be paid in full by June 9, 2007, thirty business days prior to the commencement of NCIL’s annual conference to insure voting privileges at the Annual Council Meeting.

Upon payment of appropriate dues, it shall be assumed that a member automatically supports NCIL’s mission, goals, advocacy priorities, and the IL philosophy; copies of which shall be forwarded to all members annually by the NCIL office with a notation that they are what the dues and membership support.

Required Information is noted with an asterisk (*).

Membership Year: January 1 - December 31, 2008

  

Membership

Membership Applications

.

Are you a New or Renewing Member? Please select one:

New Member

.

              Region (if known):       

              *Executive Director:    

              *Organization Name:    (please spell out, without acronyms)

              *Mailing Address Line 1:

              Mailing Address Line 2:  

              *City:                             

              *State/Territory:            

              *Zip Code:                     

                        

              *Fax:                             

              *E-mail Address:           

              Web Site (if applicable):

              *Operating Budget:      

     View Membership Dues Chart for Organizations

               Note: If you are a NEW member, you may reduce your dues by 25%!

Do you want to ensure that there is a consumer control voice advocating in Washington by supporting NCIL with an additional contribution? You will be asked to repeat this selection in the online store.

Amount of Additional Donation:

                                                               

                             


              *Total amount of payment $


*MATERIALS: All NCIL publications are mailed standard print and/or emailed in text format.  Please indicate whether you would like to receive publications in the following formats:

Braille                    CD (Text format)                      Large Print                      Tape
 

 

 

 
 
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