NPCOLLAB.ORG - Membership dues

Organization’s Annual Budget or Sales**	Annual Dues (Select One)
$3 million and more	$1,000
$1 million to $2,999,999	$500
Under $1 million	$250

Please complete the information below by June 30, 2009.

Main Contact First Name*:
Main Contact Last Name*:
Title*:
Organization*:
E-mail*:
Mailing Address*:
City*:
State*:
Zip*:
Phone*:	- -
Website:

* Funders at $1,000 or more – Please complete and return form, but do not remit dues.

**For organizations with a service area that extends beyond the North Penn Collaborative’s geography (North Penn, Souderton, and Wissahickon School Districts), you may estimate your budget applicable to the Greater North Penn region.

For questions or special situations, please contact Ella Roush, 215-234-4022, eroush@comcast.net.

Thank you for your support of regional collaboration for a better community!

Membership Application Form – July 1, 2009 through June 30, 2010

Please complete the information below by June 30, 2009.