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National Association for Children of Alcoholics
AFFILIATE APPLICATION

 

NAME OF AFFILIATE ___________________________________________________

INCORPORATED NAME _________________________________________________
(IF DIFFERENT)

ADDRESS ___________________________________________________________

___________________________________________________________________

PHONE________________________________ FAX __________________________

E-Mail_________________________________Web__________________________

CONTACT PERSON_____________________________________________________

HOW AFFILIATION WILL STRENGTHEN YOUR ORGANIZATION'S MISSION: ___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Please include the following with your application:

  1. Articles of Incorporation
  2. Evidence of 501(c) 3 IRS status or pending status
  3. Organization's mission statement and description of programs and services
  4. Annual Affiliate Fee of $250


Name______________________________________________________________

Title_______________________________________________________________

Signature______________________________Date_________________________

 

10920 Connecticut Avenue, Suite 100 Kensington, MD 20895
1-888-55-4COAS(2627) FAX (301)468-0987
www.nacoa.org

 

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