Membership Commitment Form

In consideration of the services provided by the National Community Development Association, the City (or County) of
in the state of —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming-----------American SamoaGuamNorthern Mariana IslandsPuerto RicoUnited States Minor Outlying IslandsVirgin Islands commits to establish or continue membership in NCDA and pay dues in total for the period beginning July 1, 2023 - June 30, 2024. Payment (in the form of check or purchase order or a commitment date to pay) of membership dues in the amount of —Please choose an option—Entitlement 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: $3,430Alumni 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:
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming-----------American SamoaGuamNorthern Mariana IslandsPuerto RicoUnited States Minor Outlying IslandsVirgin Islands

ZIP:

Population:

Phone:

Email:

Website:

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: