1. Membership Application

 

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* 1. Please provide us with the following information about your organization:

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* 2. Please provide your organization's contact information, including the primary contact person's name, phone number, and e-mail address.

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* 4. What best describes the classification of your organization?

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* 5. What best describes the legal status of your organization?

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* 6. How many individuals are members/constituents of your organization? This can include number of registered individuals, distribution lists, etc. (Please use a whole number. Do not include commas, periods, or any other signs. For example: type 1000 instead of 1,000.)

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* 7. Does your organization file an annual 990 form?

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* 8. Does your organization have by laws?

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* 9. Does your organization have a mission statement? If yes, then please provide it in the space below.

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* 10. Please take the time to tell us about your organization's programs. You can also use this comment box to state any additional information about your organization, if you choose.

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* 11. I am authorized to submit this application to become a member of the U.S. COPD Coalition on behalf of my organization.

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* 12. Please tell us what you would like to see the US COPD Coalition do in the coming year.

We thank you in advance for filling out this form!

**Once submitted your application will be forwarded to the Board of Directors and you will be contacted with a response. For more information on joining the Coalition please contact Jamie Lamson at 202-445-4009.

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