Membership application/ update form
Thank you for your interest in CCNC Membership! We are an active cooperative association with members from across the state as well as out of state supporters. We invite you to fill out the information below to either update your membership or apply for membership. We strive for outstanding service so will be in touch within the next business if you need a response! If you need dues information, please feel free to submit the form and we will get in touch!

Make it a great day!
Email address *
Organization Name *
Primary Contact Name *
Primary Contact Email *
Primary Contact Title *
Primary Contact Phone number *
Other Contacts to include?
Mailing Address *
What membership category are you in? *
Required
What benefits are you looking for by joining CCNC?
Would you like to advertise your products or services in the quarterly newsletter, social media or direct mail to the Council Members?
Clear selection
How large is your organization? Please share number of members, accounts, lines, or meters. If none apply, please give a short description. *
Do you have resources to share with other organizations? If so, what kind? (ie: printing house, mailing center, back office support...)
Are you looking to use other organization's resources? If so, what type of resources?
Do you offer a scholarship program or youth program that you would like CCNC to share with all members?
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