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NPower Seattle Membership Form

Thank you for your interest in becoming an NPower Seattle member! Please fill out the online membership form below. Before you start, you will need the following information:

• The basic information: including your address, primary contact, billing contact and executive director.
• Your organization's Tax ID Number or "EIN."
• Your annual budget to determine your dues based on our sliding fee scale.

When you've completed the form, press the SEND button. Print your confirmation email and send to NPower Seattle with your membership dues.

Questions? Call us at 206.286.8880, or email us membership@npowerseattle.org

Privacy Statement: NPower respects your right to privacy. We promise that ALL information you share with us on this form is for NPower's use only. We will not sell, rent, loan, trade, or otherwise transfer any information collected on our site.

* Required field.

* This is a New Member application Renewing member

1.	Organization Basics

*Organization
Executive Director
Executive Director's Email
Organization Address
*Street Address
Address line two
*City
*State
*Zip Code
*Telephone Number
Fax Number
Web Site Address
*Organization's EIN/Tax ID Number

2.	Primary Contact Information

*First Name
*Last Name
*Email
*Title	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director

Primary Contact Address
Same address as organization.
*Street Address
Address line two
*City
*State
*Zip Code
*Telephone Number
Fax Number

3.	Billing Contact Information

Same as primary contact.
*First Name
*Last Name
Email
*Title	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director
*Telephone Number
Fax Number

Billing Address
Same address as organization.
*Street Address
Address line two
*City
*State
*Zip Code

4.	Staff Email Addresses

As a member of NPower Seattle, you and your staff are entitiled to many benefits, some of which include periodic technology updates (new training calendar and/or class) and alerts (such as virus warnings). Please provide us with the email addresses of staff members you think should be on our distribution list so they will be notified when a new technology update is released.

Staff Name	Job function	Email
1.	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director
2.	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director
3.	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director
4.	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director
5.	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/Director

5.	More Information

Please tell us briefly about your organization's mission:

NPower membership dues are based on your annual operating budget.

*Annual Operating Budget

-- Please select from the list -- Budget under $100,000 Budget from $100,001-$500,000 Budget from $500,001-$1.5 million Budget $1.5 million - $5 million Budget over $5 million

How many staff work at the above location?

-- Please select from the list -- 10 or less 10 - 20 26 - 50 51 - 100 100+

Mission Focus

-- Please select from the list -- Arts and Culture Civic/Community Development Civil and Human Rights Education Environment Foundation Health & Human Services Legal Services Technology Other

How did you first learn about NPower?

-- Please select from the list -- Funder Day of Service NPower staffer NPower Web site NPower member Speaking engagement Volunteer NPower training class The NPowerLine Newsletter Another nonprofit News item A nonprofit press Other

If "Other", please specify:

6.	NPower Seattle Services

Which NPower Seattle services are you most interested in? (Check all that apply.)
	Assessing & Documenting your technology		Strategically planning for the use of your technology
	Improving your computer operations (networking; internet connectivity, backups, virus protection)		Selecting, designing, customizing a database or reports
	Updating or designing a website		Using a technology volunteer in your organization
	Print and online technology resources		NPower Community Events (Free events such as Tech Field Days & Tech Talks)
	Technology Training classes If you are interested in training, please indicate which methods you prefer: Classroom One-on-one (coaching)		Other:

7.	Name Usage Permission

After receiving numerous inquiries about NPower Seattle members, from nonprofits as well as funders, we think it would be useful to share our membership list on our website.

So what would this mean for your organization?

• The NPower Seattle website will list your organization as a member of NPower as well as provide a link to your organization's website.
• As an NPower member, funders will have the opportunity to donate our services to your organization. Your organization's name and mission statement will appear on the Donate Now webpage.
• Other promotional and marketing materials may include a list of member organizations and website addresses.
• We will NOT share organizational information such as address, phone and email addresses with ANYBODY!

* You may list our organization's name and website address listed along with other NPower Seattle Members.
Yes	No

* I understand that member rates for NPower Seattle services will not apply until our organization's membership dues have been received.

Agency's Annual Budget	Membership Dues
Under $100,000	$50
$100,001 - $500,000	$100
$500,001 - $1.5 million	$200
$1.5 million - $5 million	$400
Over $5 million	$500