Request A New Member Invoice
Contact Details
Organization Name
First Name
Last Name
Title
Work Email
Mobile Phone
Direct Line
Company Phone
Text Opt Out
Preferred Phone
Please select...
Work
Mobile
Website
Are you blind, visually impaired, or have low vision?
Please select...
Yes
No
Prefer not to answer
How would you like to receive communications?
Digital
Large Print
Billing Address
Billing Street
Billing State/Province
Billing City
Billing Zip/Postal Code
Billing Country
Membership Details
Organization Type
Please select...
Nonprofit
For Profit
Nonprofit - Nonvision specific
Grant-Making
Membership Origin
Please select...
New (For prospects that have never been members)
Reacquire (For memberships being renewed after a lapse in service)
EIN or BN Number (enter your number only without any dashes)
Annual Total Operating Expenses
(enter full amount without commas)
enter full dollar amount without any commas
Auto Renew?
One Time Purchase
Renew Annually
Select Your Membership Level
Please select...
Membership <700K ($500)
Membership 700K - 1.5M ($1000)
Membership 1.5M - 3.0M ($1500)
Membership 3.0M - 5.0M ($2500)
Membership 5.0M – 13M ($3500)
Membership 13M – 25M ($5000)
Membership 25M – 35M ($7000)
Membership 35M – 50M ($8500)
Membership 50M+ ($10,000)
Dues are based on your total annual operating expenses. Use line 18 of your 990 or equivalent document to determine your operating expenses. Visit
www.visionservealliance.org/membership-dues/
for more details.
Total Amount
$
Contact Information