COSA Membership Form for 2021
COSA membership is valid for our fiscal year July 1, 2020 through June 30, 2021.
If you have any questions, please contact COSA at
COSAhc@gmail.com
. Thank you!
* Required
Email address
*
Your email
First name
*
Your answer
Last name
*
Your answer
Organization Name (or Your Name for Individual Membership)
*
This is how you or your organization will be listed in the newsletter and on the COSA website.
Your answer
Website:
COSA will link to this address in the newsletter and on the COSA website.
Your answer
Membership Category:
*
Membership support is based on your organization's TOTAL annual budget.
Budget up to $99,999: $50 membership
Budget of $100,000 to $499,999: $75 membership
Budget of $500,000 to $999,999: $100 membership
Budget of $1,000,000 to $1,999,999: $150 membership
Budget of $2,000,000 to $4,999,999: $300 membership
Budget of $5,000,000 to $6,999,999: $500 membership
Budget of $7,000,000 and above: $750 membership
Individual Membership (unaffiliated with an agency): $25
Does your organization need an invoice to process this payment?
*
COSA will email an invoice at your request.
Yes
No
Please make checks payable to COSA. Federal ID# 04-3233858.
COSA's mailing address is: PO Box 343, Amherst, MA 01004.
Mailing Address:
*
Please include your PO Box/Street, City, State, Zip Code.
Your answer
Do you give COSA permission to add your email to our mailing list?
*
COSA regularly emails a newsletter and occasional announcements. We do not sell or share our mailing list.
Yes
No
A copy of your responses will be emailed to the address you provided.
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