Partner Application - Step 1

It's easy to become a new LBNP member or renew your existing membership. Just fill out the form on this page. You'll then be taken to the payment portion of the sign-up process where you can pay for your membership with a credit card via PayPal - Visa or Master Card only; no American Express.

If you prefer to pay by check, mail it with the completed application form. Please click here for a printable PDF form.

	If this is a renewal, check here:
	New and renewing partners, kindly fill out the form below.
	AGENCY INFORMATION
	Organization:
	Address:
	City:
	Zip:
	Website:
	Federal ID Number:
	Operating budget (based on annual revenue):
	Executive Director:
	Phone:
	Fax:
	E-mail:
	CONTACT INFORMATION (if different from above)
	Contact Person
	Title
	Phone
	Fax
	Email
	How many copies of the newsletter would you like sent to your organization?
	MEMBERSHIP CATEGORY (click all that apply)
	Nonprofit Organization Association Government Education	Consultant Interested Community Member Student
	NARRATIVE DESCRIPTION ( for inclusion in Directory - 25 words maximum)

	PROGRAM FIELD (click all that apply to your organization)
	After School Animals Art, Culture, Humanities Athletics Children/Youth Civil Rights/Social Change Community Development Environment Employment Faith-Based Food/Nutrition Gov: Elected Official Gov: City Gov: County Gov: State Gov: Federal Health: General Homeless Housing/Shelter	Legal Mental Health Mentoring Philanthropy Public Safety Religious Insitution Seniors School: LBUSD School: Parochial School: Private School: Public Social Services Volunteerism Other (explain below)
	TARGET POPULATIONS (click all that apply)
	Preschool Children <12 Youth 13-22 Seniors Gay/Lesbian Disabled Women Men	African American Latino Cambodian/Asian/Pacific Islander Native American Middle Eastern General Other
	This data will be used only in the aggregate for advocacy efforts
	Number of Staff
	Number of Volunteers
	Volunteer Hours Contributed Annually
	What programs or services are you interested in?
	Workshops Consulting Customized Training Library/Research Services Nonprofit Information	Advocacy Board Development Information Technology/Web design Other (explain below)
	I am interested in participating in:
	Executive Directors Roundtable Volunteer Managers Roundtable Other (explain below)
	Click the arrow below to continue to step 2.

Partner Application - Step 1

If this is a renewal, check here:

AGENCY INFORMATION

CONTACT INFORMATION (if different from above)

MEMBERSHIP CATEGORY (click all that apply)

NARRATIVE DESCRIPTION ( for inclusion in Directory - 25 words maximum)

PROGRAM FIELD (click all that apply to your organization)

TARGET POPULATIONS (click all that apply)

This data will be used only in the aggregate for advocacy efforts

What programs or services are you interested in?

I am interested in participating in:

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