2024 PRORATED NEW MEMBERSHIP APPLICATION

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This application is for NEW NYCON members only. If you'd like to renew an existing membership, please log into the Member Dashboard or email membership@nycon.org for assistance.

Thank You for your interest in joining NYCON! There are so many benefits to NYCON membership - we look forward to working with you!

NYCON Membership is based on the Calendar Year (January 1- December 31). Your first membership, paid here, will be prorated based on the current month. Future renewal notices start to go out in November to renew by January 1 of each year.

Future memberships will not be prorated, this is a one-time offer for new members.

Current Month

Organization Name

Organization Street Address

Organization City

Organization State

Organization Zip

Organization E-mail Address (Your receipt will be sent to this email)

Organization Phone

Enter Numbers Only! NO Comma, No Dollar Sign.

Current Operating Budget

Percent of Budget from Government

Employer ID # (EIN)

Must use the format "##-#######"

Year Incorporated

Website

County

Number of Employees (FTE)

Number of Board Members

NYCON holds Executive Director Retreats, please indicate if your Executive Director has less than 5 years experience.

YESNO

The questions below assist NYCON with advocacy efforts.

Congressional District

Is your nonprofit BIPOC led?

YESNO

Primary Service Area

Staff Information

Primary Contact

Primary Contact Salutation

Primary Contact First Name

Primary Contact Last Name

Primary Contact Email

Primary Contact Title

Secondary Staff Contact

Secondary Contact Salutation

Secondary Contact First Name

Secondary Contact Last Name

Secondary Contact Title

Secondary Staff Email

Board President

Board President Salutation

Board President First Name

Board President Last Name

Board President Email

Board President Phone Number

Payment Information

Cardholder First Name

Cardholder Last Name

Cardholder Street Address

Cardholder City

Cardholder State

Cardholder Zip

Card Number

CVV

Card Expiration Month (use two digit month, i.e. 04 for April)

Card Expiration Year (use four digit year "2027")

Discount Code

Total Before Prorate

$

Total Membership Cost

$

Your submission may take up to 60 seconds to process. Please only click "Submit" once.

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