Your Personal Details
Details for the person completing this application whether on behalf of themselves or an organization. We will use this info to follow up with you after you complete the application.
Your Full name
Your Role / Position
How would you describe yourself? Check all that apply.
Wellness Professional/Service Provider
Discount / Referral Code
If you become a member, the fields in this section will populate a public profile for your organization on our website. You can see an example here: https://www.4socialchange.org/c4sc-members/ If you do not have an organization, this section can be about you.
General Organization Email
firstname.lastname@example.org, this email will be displayed on your profile on our website.
General Organization Phone Number
A short description of your organization for our website
Smaller than 10MB and at least 400px by 400px
Pick the issue area that best describes your organization's focus.
Arts & Culture
Equality & Human Rights
Health & Well-Being
Sports & Recreation
None of the above apply to my organization
What level of engagement are you interested in? (link to descriptions below)
Private Office: Starting at $1,000 depending on availability
Shared Office: $349 per desk in an office with 2 - 3 other members
Dedicated Desk: $249
Ally Organization: $90
Ally Individual: $25
Fiscal Sponsorship: $50 (additional application required)
I'm not sure yet
I want multiple memberships
See our current membership plans
Why is your organization interested in membership at C4SC?
What is your organization's geographic scope?
Local (neighborhood/city level)
Regional (multi-city or multi-state)
National (the entire country)
International (beyond the U.S.)
$100.000 - $249.999
$250.000 - $499.999
Year Organization Founded
Number of local employees
What is your organization's mission?
How does your organization make a social impact?
How could your organization contribute to our community (e.g. with support services such as consulting, training, workshops, connections , etc.)
Do you want to offer a discount/promotion to other members? If so, what? (your answer will be visible to other members)
How did you hear about us?
Street Address (Billing or Secondary Organization Address)
Are you interested in any of the following fee-based services? If so, we will contact you with more information about cost and scope of the services. (Check all that apply)
Are you applying because you're interested in being a fiscal sponsored project? Please complete the fiscal sponsorship application once you submit this membership application.
Are there any other support services (high priority) that your organization needs? Although we may not offer the services you need, we pride ourselves on making valuable referrals and connections for our members.
Requested Start Date
Terms and Conditions
I acknowledge that by becoming a Center for Social Change member I will get weekly email updates.
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