Columbia Basin Nonprofit Association

New Member Application
Organization Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Street Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Year Inc.
Federal EIN
# Full-time Employees (30-40 hr/wk)
# Part-time & seasonal employees
Tax exempt status under section 501(c)(3) of the Internal Revenue Code is a requirement for membership in CBNA
Check one:

IRS Letter of Determination has been receivedApplication for Determination has been submitted
Service sector(s)

YouthEducationHealthElderlyPovertyOther
Executive Director/CEO
Phone
Email
example@example.com
Organization's Media tools used:

FacebookWebsite
Website URL
Key Staff or Volunteer
Email
example@example.com
Key Staff or Volunteer
Email
example@example.com
Key Staff or Volunteer
Email
example@example.com
Please refer to the following schedule to determine your annual membership dues. Annual Operating Budget should be based upon your most recently completed fiscal year, excluding in-kind services. Membership is based upon a calendar year and will renew in January of each year.
Annual Operating Budget / Annual Dues

Less than $250,000 - $50$250,000 and higher - $100Affiliate Member - $250
Make checks payable to Columbia Basin Nonprofit Association

Mail to:
CBNA
P.O. Box 6212
Kennewick, WA 99336
Should be Empty:

New Member Application