Organizational Membership Application

Organizational Information
Organization Name
Address
City
State/Province
Zip/Postal Code
Country
Type of Organization
Please check all that apply		 Private Practice 
Private, not for profit non-religious agency 
School (K ­12) 
Private, not for profit religious agency 
Private, for profit agency 
College/University
Public, governmental agency 
Other  Please Specify
Primary Field(s)
of Service
Please check all that apply 		Aging 
Family Service 
Substance abuse
Child Welfare 
Health/hospital 
Legal services
Church social ministry 
Housing 
Military		 Corrections/Justice 
Income maintenance 
Public welfare/Government
Developmental disabilities 
Industry/Business/Labor 
Youth services
Education for social work 
Mental Health 
Other  Please Specify
Budget Size Over $500,000 
$100,000 - $249,999 		 $250,000 - $500,000 
Under $100,000
No Budget

Designee Information


(Person Who Will Receive NACSW Materials and Exercise Membership Rights on Behalf of the Organization)
Name
Position Title
Work Phone& Extension 
Email Address 
Work Fax
Website Address/URL 
Special Interests Is the organization's designated person interested in participating in a special emphasis area (for example, individual counseling, substance abuse specialization,  church social work, etc.) sponsored by NACSW? If so, please indicate area/specialty: 
NO  YES 
Is the organization's designated person willing to be a contact/coordinator of special emphasis area (for example, individual counseling, substance abuse specialization, church social work, etc.)? If so, please indicate area/specialty: 
NO  YES 
Current Professional Memberships NACCFA
Christian Management Association 		 Other(s) - please list

Referral Information How Did You First Hear of NACSW? Please Specify Who

Please Specify		 First Name
Last Name
Writing/Presenting Is anyone in your organization interested in writing for NACSW's newsletter (Catalyst) or journal (Social Work and Christianity) - including sharing with other NACSW members about the work of your organization? 
NO  YES 
 Is anyone in your organization interested in presenting at an NACSW conference or convention - including sharing with other NACSW members about the work of your organization? 
NO  YES 
Is your organization interested in representing NACSW at events sponsored by your organization and/or other professional activities in which your organization participates? 
NO  YES 
Group/Chapter Activity Are members in your organization interested in participating in local group or chapter activities sponsored by NACSW? 
NO  YES 
Is your designated person willing to be a local contact/leader of a local group or chapter in your area? 
NO  YES 
Membership Certificate Information

Please indicate below exactly how you would like your organization's name to appear on your free membership certificate (for example, Christian Family Services, Inc.)


MEMBERSHIP RATES - Please choose one of the following...
Annual Budget Over $500,000 Regularly, $460
Annual Budget $250,000 - $500,000 Regularly, $372
Annual Budget $100,000 - $249,999 Regularly, $285
Annual Budget Under $100,000 Regularly, $230
 

Note: One of the other benefits of organizational membership is that NACSW will offer a discounted individual member rate to up to 3 additional employees (over and above the person the organization designates to receive NACSW materials and exercise membership rights on behalf of your organization). 

These additional employees can become individuals members of NACSW for a reduced cost for employees who elect to join and pay for their membership dues online. An employee who would like to become an individual NACSW member online can do so by visiting NACSW Member, and indicating on the online application that he/she is requesting the organizational member discount.

NACSW is pleased to offer, as an organizational member benefit, in cooperation with Evangelicals for Social Action (ESA), a subscription to ESA's premier magazine, Prism (click for more information), for only $20 - that's 40% off the regular price! 

Please add $20 to our dues payment to include a subscription to Prism magazine  No subscription   

As an additional benefit of NACSW membership, in cooperation with Haworth Press, NACSW now offers subscriptions to three of Haworth Press’s journals (click for more information) for 20% off their regular subscription rates.

Journal of Religion Disability & Health - $112 for individuals   <Please add an additional $16.80 US or $21.60 US for mailing to Canadian or overseas addresses respectively>  No

Social Thought: Journal of Religion in the Social Sciences - $100 for individuals  <Please add an additional $16.80 US or $21.60 US for mailing to Canadian or overseas addresses respectively> No

 PAYMENT INFORMATION
Please Select Currency Type US  Canadian
Please Select Card Type MasterCard  VISA  American Express
Billing Street Address and Zip Code If Different than Above Address
Card Number 
Expiration Date (MM/YY) 
Dues
Prism Subscription
JRDH
JRSS
Please ENTER Total $ 
 

I understand that by submitting this organizational membership application to NACSW, I am affirming that our organization supports NACSW’s mission and Statement of Faith and Practice. 

 

NACSW
PO Box 121
Botsford, CT 06404-0121
Tollfree: 888-426-4712
info@nacsw.org