Rural Coalition Organizational Member Form
Please complete this form to become an RC member or to renew your existing RC membership
Your Name:
First Name
Last Name
Your Email address:
example@example.com
What is your Organization's Name?:
When was your organization founded?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Mailing Address:
Parmanent Address
Present Address
City
State / Province
Postal / Zip Code
Main contact's phone number:
Your organization's logo
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Please add the names and email addresses of anyone else in your organization who should receive RC membership communications, including Member Call Invitations
Membership Options: Please select which payment tier is appropriate for your organization. We suggest the following framework:
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Basic Organizational Member
$100.00
$
100.00
$100.00 annual membership fee for organizations with an annual operation budget of less than $10,000.
Organizational Member
$250.00
$
250.00
$250 for organizations with an annual operating budget of $100,000 - $249,000.
Organizational membership
$500.00
$
500.00
$500 for organizations with an annual operating budget of $250,000 - $749,000.
Organizational Membership
$750.00
$
750.00
$700 for organizations with an annual operating budget of $750,000 - $999,000.
Organizational Membership
$1,000.00
$
1,000.00
$1,000 for organizations with an annual operating budget of $1,000,000 or more.
Supporting Organizational Membership
$1,500.00
$
1,500.00
Community Builder Organizational Membership
$2,500.00
$
2,500.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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