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NPower Arizona Membership Form

Thank you for your interest in becoming an NPower Arizona member! Please take a moment to complete the following information. Before you start, you will need the following information:

• The Basics - please include your address and contact information for your Executive Director, Primary Contact and Billing Contact.
• Organization Tax ID # or "EIN" - needed to verify your status as a nonprofit and will be kept confidential at all times.
• Annual Budget - your annual budget determines your annual dues, which are based on a sliding scale.

When you've completed the form, press the SEND button. We will invoice you once we receive the completed membership form.

Questions? Give us a call at 602-343-6797 or email us at info@npoweraz.org

Privacy Statement: NPower respects the privacy of all those that we deal with. You can feel confident all information you provide on this form will be kept confidential and not shared with other individuals or groups.

* 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

Please supply information about the person who will be NPower Arizona's primary point of contact with your organization.
*First Name
*Last Name
Email
*Title	Admin/Program CoordinatorCommunications/Fund DevExecutive DirectorTechnology SupportFinance/AccountingBoard MemberCase Manager/Direct ServiceProgram Mgr/DirectorOther
*Telephone Number

Primary Contact Address
Same address as organization.
*Street Address
Address line two
*City
*State
*Zip Code
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/DirectorOther

4.	Staff Email Addresses

As a member of NPower Arizona, you and your staff are entitiled to many benefits, some of which include periodic technology and training updates, as well as virus alerts. Please provide us with the email addresses of staff members you think should be on our distribution list so they can take advantage of these member benefits (there is no need to include contacts listed above).

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

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 -- 0-$250,000 $250,001-$1 million Over $1 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 -- Advocacy Animal Rights Arts Civic Education Environment Health Human Services International 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 Arizona Services

Which NPower Arizona services are you most interested in? (Check all that apply.)
	Assessing, Evaluating, or Documenting your technology		Long-term Technology Planning
	Improving your IT operations (internet connectivity, backups, virus protection, network upgrades, etc)		Database selection, design or customization
	Updating or designing a Web site		NPower Community Events (Free events such as Tech Tuesdays, Volunteer Days of Service or Educational workshops)
	Technology Training (classroom or customized training)		Other:
	Scheduled Support

7.	Name Usage Permission

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

So what would this mean for your organization?

• The NPower Arizona Web site will list your organization as a member of NPower Arizona.
• Other promotional and marketing materials may include a list of member organizations, such as our eNewsletter announcing new members.
• 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 Arizona Members.
Yes	No

* I understand that membership rates will not apply until NPower receives our organization's membership dues. Please note that you will be billed for membership and will be invoiced at the end of the month. Thanks for joining and we look forward to serving you!