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 begin or continue membership in NCDA and pay dues in total by the expected payment date listed on this membership commitment form. 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: