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COMMUNITY PARTNER PRE-ENROLLMENT & QUALIFICATION FORM
Thank you for taking the time to complete our Community Partner Pre-enrollment & Qualification Form.
Please provide the information requested so that we can properly assess your organization’s qualifications for membership.
It is always our commitment to offer as much assistance and as many opportunities to our members as possible. We look forward to developing and continuing a mutually beneficial relationship.
Organization Information:
Please note that fields with an (*) are required.
Name of your Organization: *
Year Formed:
Website Address:
Organization Email Address: *
Organization Phone Number: *
Organization Address: *
Street Address 1 *
Street Address 2
City *
State *
Zip Code *
Country *
Representative Contact Information:
Contact First Name: *
Contact Last Name: *
Title:
Email Address: *
Phone Number: *
How did you hear about the Community Partnership Program?
Please Explain
By Whom
Note: All information is kept in the strictest of confidence; see our Privacy Policy for more information
We sincerely appreciate your efforts. We know that the time you invested will prove to be time well spent. We will be in touch with you as soon as possible after our Enrollment Committee reviews the application. Again, it is our stated goal to consistently offer meaningful growth incentives and savings for all of our members.
Please allow 5-7 business days for review and approval by our enrollment committee.
Sincerely,
The Community Partnership Program Staff
Our Community Partner Members will gain access to all the Community Partner Benefits, Savings and Revenue Sharing Programs at absolutely no cost to your organization.
That's Right, No Cost!
CBA Name
CBA Id
"The Community Partnership Program is
designed to produce a "Sustainable" revenue stream for its
Community Partners, while providing savings to their members on
products & services"
Community Partnership Program
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The Community Partnership Program, LLC
