Organizational Membership

Organization Information

Organization or Company Name

Website URL

Facebook URL

Linkedin URL

Twitter Handle

Address

Address Street 1

Address Street 2

City

State

Zip Code

Areas of Focus - Please select all that apply.

What community-level risks do your agency's services primarily work to prevent and address that affect young people’s potential and life outcomes? Please select all that apply.

Annual Revenue

In what year did your agency start providing youth services?

What is the age range of the population for which your organization provides services? Select all that apply.

How would you describe the area where your agency programs are located? Note: Please select all that apply.

Point of Contact Information

First Name

Last Name

Title

Pronouns

Phone Number

Email

CEO/Executive Director

First Name

Last Name

Email

Finance Contact

First Name

Last Name

Email

Additional Staff Contact Information

First Name

Last Name

Title

Pronouns

Email

Phone Number

Level 5 - Membership - $4,350

I benefit from advocacy efforts geared to programs that impact the youth and families we serve, and am prepared to contribute to increase funding and public support for all of these programs. Please add $4000 to my Youth Collaboratory Base Membership!

Level 4 - Membership - $3,350

Level 3 - Membership - $2,350

Level 2 - Membership - $1,350

Level 1 - Membership - $350

I would like to join or renew my organizational membership at the minimum Organizational Member investment.

ADD ON: Young Person Sponsorship - $75

Add $75 to support young people as advocates. My contribution directly supports training and travel for youth and young adults to engage in advocacy on the federal level.

ADD ON: Customer Investment - $

Please add this additional investment to my membership fee.

TOTAL:

How would you like to pay?

InvoicePaypal or Credit Card

As a member of Youth Collaboratory, I/we affirm that I have read the mission statement, and understand that Youth Collaboratory centers our values of Equity and Liberation and Authentic Youth Collaboration in all of our work locally and nationally.

Please check to affirm

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Contact Information