Membership Application

Complete the application below to join New Light Leadership Coalition. If you are paying your membership dues with check or money order, please download the application and mail it to us with payment. Currently we only accept applications for members in North America.

Part 1. Contact Information
First Name, M.I.	.
Last Name
Organization Name *Affiliate Members Only
Contact Person Title *Affiliate Members Only
Address	Apt./Box #
City, State, Zip	,
Phone
Email
Website
Date of Birth (dd/mm/yyyy)
Gender	Male Female
Part 2. College Student Information
School Name
Classification	Freshman Sophomore Junior Senior Graduate
Degree Attaining	Associates Undergraduate Masters Ph.D. In High School Out of School
Major/Area of Study
Campus Address
Address 2
City, State, Zip	,
Campus Phone
Part 3. Survey Information
a. What is leadership to you? b. Why do you want to be a member of New Light Leadership Coalition?
Part 4. Membership Information
Choose a password to access the members only website:
Password
Verify Password
Profile Picture
Committee(s)	Sign me up for the following: Conference Committee Fundraising Committee
Choose a Membership Option: Membership Levels Dues Youth Membership (Ages 16 to 25) $25.00 Associate Membership (Ages 26+) $50.00 Affiliate Membership (Organizations) $100.00 I have read and agree with the membership pledge.* Please Verify the Image: