NH Research and Evaluation Group, LLC Org Membership Application 2012 2013

1. NHREG Organizational Membership Registration

By completing the information on this page, your organization agrees to become a formal member of the New Hampshire Research and Evaluation Group, LLC for the 2012/2013 year (7/1/12 through 6/30/13). Your organization's name will be included in the group's member directory and listed on the research group's website (www.nhresearchgroup.com).

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* 1. Please provide your contact information below (this is only for the individual who will be responsible for registering the organization's membership and maintaining a list of organizationally supported members).

* First: *

* Last: *

Title:

* Organization: *

Phone:

* Email Address: *

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* 2. What are your organization's expectations concerning your membership this year? What would define a successful partnership from your point of view?

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* 3. How many staff will be covered by your organization? Prices are based on a HALF-YEAR membership (1/1/13 thru 6/30/13)

1 to 2 ($26)

3 to 5 ($70)

6 to 10 ($140)

11 to 20 ($271)

21-50 ($621)

51-100 ($1,321)

101-200 ($2,633)

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* 4. Please list the email addresses for all staff who you would like to sponsor:

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* 5. Does your organization publish research or evaluation reports that you make available to the public? If yes, please provide a brief 2-3 sentence description of your organization along with a link to where the reports are posted. We'll post this information to the group's website as a resource for members.