States for Service (S4S) Coalition Membership Sign-Up Form

Membership Benefits Overview

Thank you for your interest in States for Service (S4S)!

To join, please complete our membership form below, and we will send you a confirmation and an invoice.

To learn more about S4S and membership benefits, please visit www.states4service.org.

Please note that S4S membership dues must be paid with non-federal funds.

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* 1. Member/Organization Name (as you would like it listed on coalition materials):

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* 2. Membership Type (dues must be paid from non-federal funds):

Individual Member ($50/year)

Programs/Partners ($250/year)

State Commissions ($500/year)

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* 3. Coalition Primary Contact Person:

First and Last Name

Position

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. Secondary Contact Person (optional):

First and Last Name

Position

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 5. Brief description of member/organization (if applicable):

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* 6. Payment Options

I will pay by check

I will pay by credit card

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* 7. Billing Contact Person (if different than above -- this is who will receive the invoice):

First and Last Name *

Position

Email Address *

Phone Number *

Checks should be made payable to the Association of State Service Commissions and mailed to:

Association of State Service Commissions
455 Massachusetts Ave, NW, Suite 153
Washington, DC 20001

ASC’s W-9 form is available at bit.ly/2s5rBoI.