Yes, I want to join NBCDI today!
The interactive nature of
this form allows you to
type your information
directly into each field.
If you experience
problems while adding
information to the fields,
or have a question
regarding this
application, please
contact us at
[email protected]
or call 202-833-2220. Membership Information
You may also register online at www.nbcdi.org.
* Required Fields
Please provide complete information.
* Name__________________________________________________________________________________________________
* Address________________________________________________________________________________________________
* City__________________________________________ * State___________________________ * Zip___________________
* Phone (W)_____________________________ * (H)___________________________ * (M)____________________________
* E-mail Address___________________________________________________________________________________________
* Organization________________________________________________ * Occupation________________________________
MEMBERSHIP STATUS:
New
Renewal
Membership Categories
Please select a membership category. Visit www.nbcdi.org for details on membership categories.
INDIVIDUAL:
Student $25 †
Regular $40
Independent $40
Regular membership includes membership in a local BCDI Affiliate, if applicable.
ORGANIZATIONAL:
Nonprofit $250 †
Corporate $500
† Student identification or proof of non-profit status must be provided.
Membership Payment
Please print the
completed form and
return using any one
of the following options:
mail: NBCDI,
1313 L Street, NW,
Suite 110,
Washington, DC
20005;
fax: 202-833-8222,
or email:
[email protected] .
We will verify the
information on your
application and send
you the confirmation
with your membership
information.
Paying by check? Please make check payable to NBCDI.
Send check and credit card payments to NBCDI, 1313 L Street, NW, Suite 110, Washington, DC 20005-4110
Credit Card:
VISA
MASTERCARD
AMEX
Please allow 10-14 business days for processing.
The address affiliated with my credit card is the same as the above address.
Billing Name______________________________________________________________________________________________
Billing Address____________________________________________________________________________________________
City__________________________________________ State___________________________ Zip________________________
Card Number_________________________________________ Exp. Date_______________ CVV Code:__________________
Signature________________________________________________________________________________________________
Donate to NBCDI!
As a member of America’s Charities Federation, NBCDI is eligible to receive your contributions from
the Combined Federal Campaign (#11574) or state, local and private sector employee campaigns.