Alliance Membership Renewal Form We are thrilled that you have decided to renew your annual Alliance membership! Just a reminder of your benefits as a dues-paying member: Fellowship and Networking with other human services leaders As a voting member, electing and serving on the Board of Directors Share your ideas - participate on an Alliance CommitteesPartnership and Education & Events Discounts on Alliance select event registration costs Early bird access to registration for Alliance events Your membership is valid for 12 months from the time payment is received. Question Title * Organization/Individual/Family Name Question Title * Who is the point of contact for your membership? Contact Person's Name Contact Person's Address Contact Person's Email Address Contact Person's Phone Number Question Title * Have there been any changes to your organization within the last 12 months that The Alliance should know about (change in leadership, new address, service area, program focus, etc.)? If so, please share that information here. Question Title * Please indicate how you'd like to pay for your membership. Online via credit card or debit card (Please use the prompt at the end of this registration form) Check or Money Order (Please make payable to "The Alliance" at 9071 Center Street, Manassas VA 20110) Invoice (Request follow-up) ACH (Request follow-up) Question Title * To pay online, please confirm your membership renewal level below and complete payment using the secure Stripe portal on the next page. Individual/Family - One Year - Regular Member - $50 - $50 USD Individual/Family - Five Years - Regular Member - $250 - $0 USD Organization - One Year - Regular Member - $100 - $100 USD Organization - Five Years - Regular Member - $500 - $0 USD You’ll enter payment info after the survey. Submit Registration
