Grantmaker Membership Application - Maine Philanthropy Center

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Grantmaker Membership Application

* Denotes Required Field

Today's Date:

* Primary Contact Name:

Title:

Email:

* Organization Name (as listed on MPC Membership Page):

Address:
* Street Address

* City

State

* Zipcode

* Phone:

Fax:

Website:

Additional names & e-mails for program announcements:

Grantmaker Type:

Community

Corporate

Donor Advisor

Family

Independent

Public

Membership Fee:

$300 (Up to $50,000)

$600 ($50,000 to $100,000)

$1,200 ($100,000 to $500,000)

$1,800 ($500,000 to $1,000,000)

$3,000($1,000,000 and up)

Please send a check to:
The Maine Philanthropy Center USM Glickman Family Library
PO Box 9301
Portland, Maine 04104-9301
or you may pay at this time via Credit Card after you click Send