Member Dues Worksheet

If you would like to complete the fillable PDF instead, click here: 2023 Dues Worksheet Fillable

Name(Required)

First Last

Job Title(Required)

Email(Required)

Program Name(Required)

Has your Program's mailing address changed in the last year?

Yes

Mailing Address

(Only if changed since July 1, 2022)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Exceptional Circumstances/Hardship Application (Please indicate)

N/A

Exceptional Circumstances

Hardship

Exceptional Circumstances Application(Required)

If Exceptional Circumstance, please identify any components of the Operational Expenses that you believe meet the definition of Exceptional Circumstances and explain why. A member of the Board or its designee will consider the request and may contact you with additional questions.

Hardship Application(Required)

If Hardship, please explain the nature of the need, including the anticipated duration of the hardship, and the proposed reduction in dues or proposed alternative payment schedule. If your organization is unable to pay even reduced dues, please submit financial evidence supporting a need for a full dues waiver. A member of the Board or its designee will consider the request and may contact you with additional questions.

Operational Expenses, fiscal year ended 2021 (exclude grant distributions, LRAP distributions, and the audited value of in-kind/contributed services)(Required)

Amount requested to be deducted based on Exceptional Circumstances(Required)

Hidden

Subtotal

Hidden

Estimated Dues

Hidden

Estimated Dues (hidden)

Payment Options

Please send me an invoice

ACH/Wire Transfer

Mailing a check

Dues Amount

Your calculated Dues Amount is $500.

Your calculated Dues Amount is $5,000

If you would like NAIP to send you an invoice, please click on Submit

Your invoice will be emailed to the address submitted above within 48 hours.

If you would like to pay via ACH/Wire Transfer, please click on Submit

Wiring Instructions will be provided to you.

If you would like it mail a check, please click on Submit

Please make the check payable to NAIP and mail it to 110 Horizon Drive, Suite 210, Raleigh NC 27615

Member Dues Worksheet

Your calculated Dues Amount is $500.

Your calculated Dues Amount is $5,000

If you would like NAIP to send you an invoice, please click on Submit

If you would like to pay via ACH/Wire Transfer, please click on Submit

If you would like it mail a check, please click on Submit

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