Business Partner Membership Application Form

Business Partner Membership Application
Name of Business*
Primary Organizational Address*
Website
Type of Business*
Example: Consulting, Retail, Food Service, Bank, Healthcare
EIN or Business Tax ID*
Primary Representative Name*

First NameLast Name
Job title:*
EX: Executive Director
E-mail*
example@example.com
Cellular Number*
Annual Budget Range*

Below $50,000$50,000–$150,000$150,000–$250,000$250,000–$500,000Above $500,000Not Applicable
Geographic Area your Organization serves*
Primary Impact Focus / Services Provided*
Organizational Needs or Partnership Interests*
As a member of the Dallas Legacy Mission Coalition of Hispanic Nonprofits of North Texas, you grant permission for DLMCHNNT to share your organization’s name, logo, photographs, and information on social media, newsletters, and the Coalition website.
Media Authorization*

YesNo
Please Share your Organization Logo

Cancelof
Submission of this application does not guarantee acceptance into the Coalition.Dallas Legacy Mission reserves the right to update membership policies with appropriate notice.By signing below, you confirm your organization operates in good standing and aligns with Coalition mission and applicable regulations.*

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Date*

MonthDayYear
Date
My Products*
prevnext( X )
Business Partner Membership
$200.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.