CIPC Organizational Membership Application 2016
Instructions for Application:
1) Fill out form completely
2) Pay online or mail check to address provided
3) CIPC staff will follow up on the receipt of applications shortly after submission
Organization Name *
Please write out the complete name of your organization for public listing.
Your answer
Street Address *
Include unit number if applicable
Your answer
City *
Your answer
Zip Code *
Your answer
Organization's Website
Your answer
Organization's Mission *
Your answer
Organization's Non-profit Status *
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