Type of Membership you are registering for:
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STUDENT (full time) - $50
INDIVIDUAL AND/OR CONSULTANT - $100
NP ORGANIZATION (budget <$50,000) - $50
NP ORGANIZATION (budget >$50,000) - $100
INDUSTRY PARTNER (Budget < $1 mil.) - $500
INDUSTRY PARTNER (Budget $1 mil.+) - $1000
SUPPORTING MEMBER - $2500
FUNDER’S CIRLE - $5,000
FUNDER’S CIRLE - $10,000
FUNDER’S CIRLE - $25,000
FUNDER’S CIRLE - $50,000
FUNDER’S CIRLE - other amount (write in below)
Funder's Circle - Other Amount (please write in the amount you would like to give)
Are you representing a currently recognized 501(c)(3) organization?
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Yes
No
Name of Organization / Group (write ‘NA’ if not applicable)
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Name of School/Institution (if registering as Student)
Contact’s First Name
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Contact’s Last Name
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Job Title / Position
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E-mail
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Work Phone
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Cell Phone
Fax
Organization Website
Street Address
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Address Line 2
City
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ZIP
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What TOP THREE business areas would you like to learn or improve? (check only three)
Advocacy
Board of Directors/Governance
Ethics/Accountability
Evaluation
Facility Management
Financial Management/Budgets
Fundraising
General Nonprofit Management
Human Resources
Information Systems/Technology
Legal
Marketing/Public Relations
Operations/Process Improvement
Startup
Strategic Planning
Volunteer Management
Other (write in below)
Other
Why are you joining? What would make your C-One membership most valuable?
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ABOUT YOUR WORK (for Organizations Only):
Number of years operating
Less than 1 year
1-4 years
5-9 years
10-19 years
20 or more years
Current annual budget
< $50,000
$50K-$249K
$250-499K
500-999K
$1 million+
$5 million+
Full-time paid staff (FTE)
No paid staff
1-2
3-4
5-9
10-19
20-49
50-99
100 or more
Number of volunteers on Board of Directors
N.A.–No board
1-9
10-19
20-2
30 or more
Number of non-board volunteers annually
N.A.—No volunteers
1-9
10-19
20-49
50-99
100 or more
Main Target Populations (only check those that significantly characterize your organization’s work)
African-American
Asian American
Haitian-American
Latin-American/Hispanic
Children (0-12 years)
Teens, or Youth “At-Risk”
Foster Care/Adoption/Abuse
Families
Elderly
Women and Girls
Gay/Lesbian
Faith Community
Other (write in below)
Describe Other
Main Services (only check those that significantly characterize your organization’s work)
Animals
Legal Services
Arts & Culture
Nonprofit Management, Organizational Dev./Training/Consulting
Basic Needs, Homelessness, Hunger
Sports, Community Recreation
Education
Substance Abuse
Environment
Victim Services, Ex-Offender Services, Crime, Public Safety
Health (Physical and/or Mental)
Vocational Training,
Employment
Housing, Community Development
Volunteerism
Other (write in below)
Other
Main Geographic Areas (check the options that best describe the main areas where your services are targeted)
ALL
Miami-Dade
Broward
Palm Beach
Martin
Other/Specifics (write in below)
Specific Areas (describe regional, neighborhood, city, state or other areas that you serve)
Organizational Status (select the option that best describes the current state of your nonprofit
Young, start-up, or “early-stage” organization: May lack formal business infrastructure and staffing.
Growing or “mid-Life”: May be in a natural state of infrastructure development; with staff wearing “multiple hats.”
Mature: May have sophisticated operations and business culture; and have some business expertise among staff.
Transition/Turnaround: May be engineering major change and/or addressing significant internal/external challenges.
Other/Comments (write in below)
Describe Other
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