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NPower PA Membership Form

Thank you for your interest in joining NPower PA!
Please complete the membership application below.
Questions? Call 215-557-1559 or contact us online.

Organization Basics

Organization Name
Address Line One
Address Line Two
City  State   Zip 
Phone example: (999) 999-9999
Fax example: (999) 999-9999
Employer Tax ID Number (from IRS 501(c)3 letter)
Website Address
How many employees work at the above location?
How many locations does your organization have, including the one above?
If more than one, will you need NPower˙s services at these other locations?

Area of Focus

What is your organization's area of focus?

Primary Contact

Who will be NPower˙s Primary Contact Person at your organization?
First Name
Last Name
Title
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Billing Contact

Who is the Billing Contact at your organization?
First Name
Last Name
Title
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Executive Director

Who is the Executive Director of your organization?
First Name
Last Name
Title
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Training Contact

Who at your organization would like to receive updates about our Training Calendar, Special Free Events and more?
  1. To add multiple Training Contacts for your organization please send their e-mail addresses to Training@NPowerPA.org
  2. If any of the above fields are the same as the Primary Contact, you may leave them blank.
First Name
Last Name
Title
Email
Email - confirm (Enter E-mail again to avoid typographical errors)

Membership Fee

Power PA˙s membership fee operates on a sliding scale according to your organization˙s operating budget as shown below:
Annual Budget and Membership dues
Over $5 Million $400
$1.5 Million - $5 Million $300
$500,000 ˙ $1.5 Million $200
Under $500,000 $100

Please select your organization˙s operating budget as it is listed on its most recent IRS Form 990.

Payment Information

Your organization can pay its membership fee in one of two ways. Please check the appropriate box to indicate which method you prefer. Your organization˙s membership to NPower PA and discounts on our services will begin upon receipt of the membership fee.
I am mailing a check made out to "NPower PA" in the amount of:
 

Membership dues should be mailed to:

NPower PA
1211 Chestnut St., 4th Floor
Philadelphia, PA 19107

Please invoice our organization for the full amount of membership fee as set forth in Section C.