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NNCG RENEWAL FORM
Member name:
Title:
Organization:
Annual Dues
2015 Firm Membership Dues:
2015 Individual Membership Dues:
$1,250.00
$ 395.00
Individual Members, involve your colleagues in NNCG by becoming a Firm/Institutional Member.
Individual Members who practice in a firm are encouraged to renew at the Firm/Institutional Member level, enabling up to
five qualifying staff and associates to receive member benefits as part of the regular Firm dues. Your firm and
representatives of your firm may participate as Full or Associate Members, depending on level of experience. Contact
[email protected] for more information.
Associate Members, are you eligible for Full Member status?
As an Associate Member, you may qualify for Full Member status by providing as references the names and contact
information for five grantmaker (or grantmaker network) clients for whom you have provided paid philanthropy-related
consulting services. NNCG will contact your references in a fully confidential manner. Return reference names and
contact information with this paid invoice, or contact NNCG at [email protected] for more information.
Please indicate any staff or address changes below*:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
*Firm/Institutional Members: Please note that any new staff joining as Full Members will need to be fully vetted before
added to your Firm Membership. For each, please provide the names of five grantmaker (or grantmaker network) clients,
indicating two who can be contacted by NNCG as references. Firms may appoint up to five representatives; the dues for
each additional firm representative are $250.
Select one of the following annual dues:
 Full Member—Individual $395
 Full Member—Institution/Firm $1,250
 Associate Member—Individual $395  Associate Member—Institution/Firm $1,250
 Additional payment of $_______________ (to support NNCG).
TOTAL: $__________________
Payment:
 Check enclosed (Payable to “Tides Center/NNCG”)
 Credit card—choose one:
 Mastercard
 Visa
 Discover
Account #
 American Express
______________Exp.
_______
Print name as it appears on your card
Signature___________________
Mail or fax to NNCG:
PO Box 40272  Cleveland  OH  44140  Fax 440.273.5325  [email protected]  www.nncg.org