Membership Commitment Form In consideration of the services provided by the National Community Development Association, the City (or County) of in the State of Select a StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWashington D.C.West VirginiaWisconsinWyoming commits to establish or continue membership in NCDA and pay dues in total for the period beginning July 1, 2021 through June 30, 2022. Payment (in the form of check or purchase order or a commitment date to pay) of membership dues in the amount of Select Your DuesEntitlement and Insular Area: Under 50,000: $550Entitlement and Insular Area: 50,000 – 100,000: $940Entitlement and Insular Area: 100,001 – 250,000: $1,545Entitlement and Insular Area: 250,001 – 500,000: $2,000Entitlement and Insular Area: Over 500,000: $3,430———————–Alumni Members: $175Affiliate Member: $2,500Non-Entitlement Member: $375Subscriber Member: $375Student Member: $50 will be forwarded to NCDA*. You may also pay online after submitting your application. Expected payment date: . First Name: * Last Name: * Title: Agency: Address: City: State: Select a StateAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutWashington D.C.DelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissourriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming ZIP: Population: Phone: E-Mail Address: * Web Site Address: Statement Against Sharing NCDA Member Information or Soliciting NCDA Members As an NCDA member, I agree not to share any materials or information produced for NCDA members, including but not limited to the following: Membership database or list Washington Report Newsletter E-mail alerts Any items on the Members Only page of the NCDA Website Log-in information Any other NCDA materials or information Further, I agree not to solicit the NCDA membership in any manner. Please type “Yes” to acknowledge that you have read and fully understand these requirements: *NOTE: Your 50% discount will be applied at checkout.