Become a Member

Posted Sat, 08/29/2009 - 17:17 by ICN

Interested in becoming an ICN member? Please fill out the "Interagency Council of Norristown Membership Form" below. We look forward to hearing from you! If you would like to download and print this form to fill it out by hand, click this link: Download this form Here

Please check one type of membership: *

$75 Non-profit organization with a budget under $1 million

$125 Non-profit organization with a budget $1 million and over

$125 Government/public (state, county, local) department

$125 Public School District

$125 Private for-profit enterprise

$55 Individual (not serving as organization representative)

Please select the type of membership you are interested in.

Agency Information

Please type all information.

Agency Name:

Address

Street:

City/Town:

State:

Zip Code:

Phone Number:

Fax Number:

Agency Email: *

You will receive a copy of this submitted form at this email address.

Web Site:

Contact Information

Key Contact:

The Key Contact person is the main agency contact person for ICN who is responsible for distributing ICN information to the other agency members for all planned events or meetings.

How many direct service staff does your agency have?:

Preferred Contact Methods:

Please send my monthly mailing through regular mail.

Please send our monthly mailing through emails (fill in emails below)

Each agency is encouraged to receive monthly mailings through the regular email. Please choose how you would like to receive your mailings. If you choose regular mail only one mailing will be made per agency and this mailing will be made to the key contact person. If you choose email, up to three email mailings will be made per month (one of which must be the key contact person). Email documents will be emailed in Microsoft WORD.

monthly mailing emails

you only need to fill this section out if you checked "Please send our monthly mailing through emails" above.

Key contact email:

2nd email:

3rd email:

Person filling out this form:

Your Phone Number:

ICN Agency Connections Directory

For inclusion in the Connections guidebook and the Agency Guide section of the ICN website please complete the following information.

Contact name and/or position title to be placed in the guidebook and on-line:

Please check the category that best applies to your agency:

Hold Ctrl while clicking to highlight more than one.

Please provide a short one paragraph description of services:

Last-Minute Fine Print

If needed, this form can be duplicated and submitted as an invoice to your agency for payment. Please return membership form and payment by November 1, 2009 to ICN, P.O. Box 697, Norristown, PA 19404. Thank you. The Interagency Council of Norristown reserves the right to edit all information to comply with the format of the guidebook. Submission of this form does not guarantee inclusion in the ICN’s resource guidebook

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