Membership Checkout - Common Good Vermont

Membership Information

You have selected the $500,000 to $1M (1 year) membership level.

$300 per year

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Account Information

Username

Password

Confirm Password

Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! " ? $ % ^ & ).

Email Address

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Full Name LEAVE THIS BLANK

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Organization Information

Organization Name

Primary Email

Organization Website

Organization Logo

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Organization Type

Organization Annual Operating Budget

Subsector

Organization Social Media Accounts

Please list platform and handles

Organization Mailing Address

Address 1

Address 2

City

County

State

Postal Code

Membership Contact Information

First Name

Last Name

Position Title

Principle Location Address

If same as mailing, check box and skip section

Address 1

Address 2

City

County

State

Postal Code

Group Account Information

This purchase includes 5 additional seats.

Group members will be able to claim the 1 Year - Additional Team Member membership level.

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Payment Information

Card Number

Expiration Date

CVC

Discount Code

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